Twilight sleep in America: The Truth about Painless Childbirth

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I

jiiUGHT Sleep

! I! U AMERICA.

9i3 in/ess Chi/ddiWA

A. SMITH, M. D.

33 2_ y ^ PPUCE 2S CENTS

5fe4 ■

1915

TWILIGHT 5LLEP
IN AMERICA

THE TRUTH ABOUT
PAINLESS CHILDBIRTH

By A. SMITH, M. D.

( t« • * • » »

» I

c- «.

THE VICTOR PUBLISHING CO.

35 6ih AVENUE
NEW YORK

\ .

Copyright, 1915, by

THE VICTOR PUBUSHING CO.

NEW YORK

.••

• • •

• •

,• •

• •

••

C

• • •

. • • •• ••

• •

I UUl-

S4.4-
I 915"

POEEWOBD.

i

Twilight Sleep lias been known to the specialist in ob-
stetrics for a number of years. Several years ago phy-
sicians returning home from Germany brought accounts
of painless childbirth. In the larger hospitals and clin-
ics it was given a trial. Whether the technique was
faulty or the drugs used not stable it is hard to say ; suf-
fice to relate that Twilight Sleep was a dismal failure
and, therefore, discontinued.

In the Spring of 1914 those doctors who confine their
work to obstetrics again experimented with this painless
method of childbirth and were careful to follow, in every
detail, the technique as carried out by the workers at
the Frauenklinik at Freiburg. They gradually became
aware that they were on the right track and that there
was something in "Twilight" after all.

In the early Summer of 1914 McClure'a Magazine be-
gan a series of articles on the general subject of Twi-
light Sleep. In Great Britain an English publication
began a similar series. The women of America, Eng-
land and of other countries, read of the wonderful re-
sults obtained from the scopolamine-morphine method
used in labor eases. The majority of physicians, for
the first time, learned of the possibilities of painless
childbirth. The more conservative called it a passing
hysteria and behttled the method.

The newspapers, knowing it was good news, gave much
space to the subject. At first, accounts of women giving
birth to live babies and without pain filled the columns.

406fi7 _j

FOBEWOBD.

Later, various physicians, some of repute and honest
in their convictions, and others unknown but seeking
free advertisement, leaped into print and criticised, from
every angle, this new-old method. Other magazines had
articles on Twilight Sleep and "noted" doctors aired
their views. At the time, it is safe to say that not as
many as two hundred women in a)l the United States
had been "Twilighted". Many extravagant claims were
published. The laity conceived the idea that Twihght
Sleep was a panacea for all pathological obstetrical con-
ditions.

Women flocked to the offices of their physicians seek-
ing to learn the truth. No small number of the doctors
were as uninformed upon the subject as were their pa-
tients. Some were frank and truthfully admitted that
they could not answer questions pertaining to this
method. Others, just as ignorant but not as truthful,
told their patients that it was dangerous both to mother
and child, that it would not and could not last, that it was
a "fake," and some even went so far as to impress upon
their audience that it was against the dictates of God and
nature.

The press ceased to publish Twilight Sleep articles.
The specialist continued to give it a fair and thorough
trial. "Women were and are still asking, "What do you
know about Twilight Sleep? Is it dangerous? What
are the after effects? What about the baby? Could I
have it in my case?"

Thousands of women in America have been "Twi-
lighted" up to the time tliis is written. Twilight Sleep
is no fantastic dream. It is a reality. It is here to stay.
Every new and many old methods in medicine and sur-
; e opponents. Therefore, it is but natural that

Twilight Sleep in Amebica. 5

many men, the Tinknown country doctor and the city
specialist, will continue to frown upon Twilight Sleep
and give it no place in their work.

Physicians from all parts of the globe, however, are
flocking to the hospitals conducting Twilight Sleep cases,
and under the instruction of the Visiting Obstetricians
are learning the proper technique, indications and con-
tra-indications of this method. In time Twilight Sleep
will be a routine procedure with many doctors in certain
types of cases.

Hoping to correct errors of information, to give first
hand the truth concerning Twilight Sleep, trusting that
the facts presented for the reader's consideration will
prove instructive, this small work has been written.

The Authob.

TWILIGHT SLEEP IN AMERICA.

^ CHAPTER 1.

^^ "Why Twilight Sleep?

For centuries the average woman has suffered paiu
during the process of bearing children. This statement
applies to the average woman. There are isolated cases
of childbirth in which the mother has endured little or
no physical and mental suffering. This type of case is
rare. The first baby, as a rule, is the worst from the
standpoint of paia. Every physician, who has attended
women during this critical period, can tell of no small
number who have bad an easy labor and experienced a
minimum of esbaustion following the happy advent of
the offspring. In the majority of instances these are
women who have had one or more children. In some rare
eases the first baby occasions practically no anguish.
Any doctor who has enjoyed a large obstetrical exper-
ience knows of women who have had an easy time with
the first, second, or third baby and have suffered the tor-
tures of the damned during the birth process of the next
child. Therefore it is impossible to foretell what a pros-
pective mother will be forced to endure.

The physician, however, in observing certain signs and
taking cognizance of various fixed laws, in a measure,
can play the prophet and, to a certain degree, foretell
the type of the coming confinement. He observes the
physical build of the woman. He measures her pelvic
bones. He learns whether the birth canal is of a size to
admit of the child's head. He, in a way, can tell whether

Twilight Sleep in Ambbioa.

the child's head is of the average size and whether there
is any appreciable disproportion between that head and
the diameters of the birth canal. The skilled obstetri-
cian, in a majority of instances, can tell his patient
whether she will deliver normally or have to undergo a
CfEsarian operation. A Caesarian operation means that
the woman is put under the influence of an anaesthetie
and the abdomen and womb opened and the baby deliv-
ered through this abdominal incision. So perfect is the
technique of this operation that, in the absence of infec-
tion or previous shock from various causes, only a small
number of the mothers fail to recover and leave the bed
at the end of from ten days to two weeks.

The position of the child in the womb at the time of
labor has much in making for an easy or a difficult de-
livery.

In a normal case the baby in the womb descends head
foremost. The back of the child's head faces the moth-
er's abdomen. Should the back of the child's head face
the mother's back, or should a shoulder be presenting,
or the child Ue transversely, or the feet present, etc.,
the position makes for complications and, in many in-
stances, a difficult delivery.

No small number of people, usually ultra-religious, be-
lieve that the words of the ancient Hebrew, "In sorrow
thou shalt bring forth children," are literally true and
govern every confinement ease. These people either fail
to think and apply their knowledge or else they are ig-
norant. As we know, all women do not bring forth their
children in sorrow, even in this age of civilization. As
the God of one is the God of all and agreeing that He is
a just God, the fair minded will not admit of this state-
ment because what would apply to one should apply to

J

Why Twilight Sleep?

all. If there are cases among civilized peoples where the
women do not suffer while bearing their children it ia
also true that the further away from civilization we
travel the more simple and painless is the process of
birth.

To the student the thought that the savage woman pre-
sents the normal obstetrical condition impresses itself.

We know that among primitive tribes, the American
Indians, and uncivilized people, the woman in labor suf-
fers practically no pain. Furthermore the more unciv-
ilized and primitive the woman the shorter is the time of
labor. This is the ideal state. A woman in labor two
to three hours, enduring no physical suffering, a few
hours post-partum giving no evidence of having given
birth to an offspring, normal in vitality and storing up
no disagreeable memories in her brain cells, this is what
all labor should be, but alas, such a case is rarely known
to the city doctor.

We know from good sources that an Indian woman
hunting with her tribe has suddenly realized that she
was about to give birth to a child. Allowing the mem-
bers of the tribe to proceed the pregnant woman has
abandoned her horse, usually near a stream. Spreading
an old Buffalo robe on the ground, or making a blanket
of dried bushes and leaves, she has had her baby. Cleans-
ing herself in the running water, she has bundled up the
new baby, mounted her horse and overtaken the other
members of her tribe. As a rule, though, the Indian
mother was accompanied by another woman and kept
apart from her people until the delivery was over. Prom
what we can learn these people rarely suffered pain, and
an abnormal case was exceptional. Of course there must
have been abnormal eases, and women died during child-

10

TwiuoHT Sleep in America.

birth, and many babies were born dead, but taking the
Indian and averaging the taaes we have record of, theirs
Was an easy state during the dehvery as compared to the
average woman of to-day.

Englemann's book, "Labor Among Primitive People",
for pages, dwells with authentic reports of labor cases
with an absence of pain.

We have learned that when we approach civilization
the suffering coincident to and the length of time for a
labor case is multiplied in proportion to the distance
from the primitive and to the nearness of civihzation.
Therefore, for esample, the half eivihzed Mexican wo-
man is usually in labor from four to six hours and suf-
fers a mild degree of pain.

And so we come to the people about us. We live bene-
fiting from the by-products of civilization. The woman
of to-day, enjoying this civilization, as a rule, looks for-
ward with dread to pregnancy and the delivery of her
offspring. And well she may, for more than one physi-
cian has said that were it possible for him to bear a
child, from his knowledge of the suffering it entails, race
suicide would be vogue.

Let us dwell awhile and learn, if we may, the causes
for this universal suffering of maternity.

Among the primitive peoples intermarriage with mem-
bers of other tribes was not the rule. If one member of
a tribe did intermarry, in many instances, they made
sure that the stature of the individuals was similar. Onr
tribe averaging five feet in heighth would not intermari
with a tribe averaging six feet in heighth. They learnc
that if a woman standing four feet, married a man of
tribe who, as a rule, was five feet ten inches in statur
the child would be out of proportion to the measureme'

Why Twilight Sleep f

of the mother 'n birth canal and dead mothers and babiea
might result.

This rule is not observed among the people of civili-
zation. Intermarriage is common between people of
different nationalities. In America it is the rule rather
tha,u the exception. For this reason, although both the
man and woman be of average statue, a woman with nor-
mal measurements will have a child in-utero of such a
size that a normal birth is impossible, or if possible, very
difSeult. This disproportion, to a certain extent, makes
for difficult labors and pain.

Among civilized peoples the more idle the life of the
woman the more painful and difficult, as a rule, is the
labor.

Among the German peasants, the hard working Danes,
the muscular Swedes, the minimum of pain endured as
compared to the American girl of fashion cannot but be
contrasted by those who have bad experience with both
tjTies. You naturally ask, "Why is this the case?"

The womb is a muscular organ. The abdominal mus-
cles have a function to perform in all labor. Before a
child can be born the cervix (neck of the womb) must
dilate to a sufficient size to permit of the passage of the
child's head. The muscular contractions of the womb,
aided by the abdominal muscles, cause the child's head
(in a normal case) to dilate the cervix and force the child
into the world.

Among the uncivilized peoples and certain civilized
nations of to-day, the females perform a certain amount
of manual labor. They work. Fix this idea fast in your
mind. They work and as a result the womb is devel-
oped as are the abdominal organs. Following this train
of thought, it is but natural that when such a type of

^^ bee

^^L mm
^^K doe

12 Twilight Sleep in Amebica.

woman goes into labor, her muscular mechanism and her ^
nerve reserve are in a perfect state. The cervix dilates
causing a minimum of pain. The muscular contractions
are regular and have force. The result is a fairly quick
delivery with practically no nerve fatigue following. The
womb is quick to contract to its normal size. This is pos-
sible because it is a developed organ both from a muscu-
lar and a nerve standpoint. The nervous system being
in such excellent condition the mother produces rich milk
in goodly quantity. She is able to nourish her child and
with food to spare. She can arise early and go on with
her duties.

Is it necessary to give a resume of the life led by the
average American girl of to-dayi The country girl leads
a better existence (from a medical viewpoint) than does
her city sister. Let us pause and see what kind of life
is led by the average girl of a large city.

She begins her schooling at six years of age. Before
she is ten years old she goes to "parties", remains awake
long past her bed hour and draws on her nerve reserve.
She is beginning her career of burning the candle at both
ends. By the time she is fourteen years old she finds
"parties" a bore and begins to ape her older sisters.
She is hardly launched on the road of womanhood when
she studies the styles in corsets. At eighteen she will
tell yon that she would get a back-ache if she left them
off a minute. Her exercise may be a sporatic try at
tennis during the warm months or an attempt at golf.
Ten city blocks is a long walk. (There are exceptions —
this we admit). For years the French heeled shoe has
been fashionable. She is a slave to the latest mode and
must wear them. Only when she plays tennis or golf
does she take to flat-heeled, common sense shoes and, in

J

"Why Twilight Sleep! 13

many cases, she complains of aching feet in a surpris-
ingly short time. Every few years we are met with a
new walk or manner of bending the body. We have
laughed at the Greeciau bend. We have suffered the
debutante slouch. Late to bed . . late to rise . . has
been the slogan. She suffers from chronic constipation.
At twenty she has "nerves". She has never learned to
breathe properly. She dabbles at her food and lives on
impossible dishes. She is a victim of auto-intoxication.
Her one aim in life is to make herself attractive, and for
real strenuous exercise she crochets ends for towels or
works monograms. Her waist line is constricted. Her
hips for years have been tightly encased in corsets pre-
venting a proper blood supply. In all fairness, we must
admit that the style of corset of to-day is bordering on
the sensible and is modelled with an idea of physiological
principles. But corsets are still an abuse. Should we di-
rect our attention to the child of fashion as we find her
in all large cities, we discover other and worse vices.
Before she is twenty years old she knows several brands
of cock-tail, has her preferences for what makes of
whiskey will constitute a pleasant high-ball and orders
the wine that happens to be the rage. We are not con-
cerned whether this is her privilege or not, ethically
it may be, but from the standpoint of bearing children it
adds to the pathological.

Add slightly to or detract from this description and let
us see this gir! married. Her nervous organism is far
from normal. Her abdominal muscles are flabby. It
may be said that she has no abdominal muscles. She is
neurotic. And then she becomes pregnant. When the
time for her baby arrives she is poorly equipped for the
experience. She goes into labor. We assume her meas-

14

Twilight Sleep in Asibbica,

urements, the child's measarements and position to be
normal. Before she is fairly launched on her labor she
becomes fretful and cries out that she knows she won't
be able to stand the pain. The uterine contractions in-
crease in power and occur at shorter intervals of time.
She yells with the pain and begs the doctor to "do some-
thing". Just when she requires her nerve reser\'e it is
exhausted. Just when her muscles have a function to
perform they tire. What then? She can't go on with
her labor. She suifers agonizing pain but there are no
expulsive contractions. The physician either gives a nar-
cotic which induces sleep and thus permits her to re-
cover her muscular and nerve power, or else he employs
a general anesthetic and delivers the baby with forceps.

What of the mother after the baby arrives? In this
ease she is usually a pitiful sight. To look at her a few
hours later or the next day one readily gathers that she
has been through a severe ordeal. She is tired. She
will tell you that she is completely "done up." She is
exhaustion plus. She looks pale, wan. She either pro-
duces no milk or else the milk is of poor quality. Ten
days or three weeks later she tries sitting in a chair.
Many days later she attempts to go out of doors. Weeks
have passed before she is anywhere near her old self
again . . and lier old self, at best, presents a poor speci-
men of womanhood.

What of the next baby? Aak any woman of this type,
and they are not rare, when she expects to have another
baby. The answer comes quickly. She will not have
another child. Six months later she says the same thing.
Two years later you get the same answer. She remem-
bers her labor as one remembers a nightmare. The
thought of another child makes a chilly sensation shoot

J

Why Twilight Sleep? 15

liirough her spine. A terrible dread fills her being when
she thinks of herself going through another confinement.
Nothing will induce her again to become pregnant. She
resorts to any means to keep from conceiving. She pre-
sents the picture of the one child sterility, from choice.

From what has gone before the reader must not form
the opinion that this is true in all cases. There are
women who, although they suffer and have hard labors,
are not made invalids and cheerfully bear other children.
There are women who dread pregnancy but still become
pregnant several times. Some do this as a matter of
duty, or it resolves itself into a religious or personal is-
sue. Some women lead simple, hygienic lives, conceive,
expect an "easy time" and suffer untold agony.

Therefore it being an established fact that no small
number of women endure exquisite pain during the pro-
cess of childbirth, are nervous wrecks for weeks follow-
ing the birth of the baby, and practice future sterility
because they fear and dread the anguish of another con-
finement . . science has at last solved their problem.

For the woman who bears children easily; for the wo-
man who has no apprehension of the future delivery ; for
the woman who has had several children and does not
think labor any extraordinary ordeal, Twilight Sleep is
of little interest to them.

These pages treating of the general subject of Twilight
Sleep are intended for the woman who fears the ordeal
E childbirth.

Twilight Sleep in America.

OHAPTEE 2.

The Evolution of Twilight Slebp.

I

In order to get a clear and logical understanding of
Twilght Sleep a consideration of the discovery of anses-
thesia and what it has done for the human race is nec-
essary. The beginning of anEesthesia goes back to re-
mote antiquity. It is symbolized in the 21st verse of the
2nd Chapter of Genesis; "And the Lord God caused a
deep sleep to fall upon Adam, and he slept : and he took
one of his ribs, and closed up the flesh instead thereof,*'

Passing periods of time we read of the soothing Egyp-
tian nepenthe of the Odyssey which Helen east into the
wine for Ulysses to partake of. The Talmud speaks of
the "samme de shinta". In the Arabian Nights we read
of the "bhang". Shakespeare tells us of the "drowsy
syrups". The Orientals well knew the soporific proper-
ties of opium, Indian Hemp (Cannabis indica), the man-
drake, henbene (Hyoscyamus), dewtry, hemlock and let-
tuce. The Greeks also knew of these drugs, and their
effects when taken. Hugh of Lucca and his son Theo-
dorie, famous surgeons of medieval times, used a mix-
ture of some of the above mentioned drugs ("oleum de
lateribus") as a surgical anesthesia.

The use of such natural antiseptics as extreme dry-
ness, smoke (creosote), honey, nitre, and wine was long
known to early man. The use of such narcotics and

ong j

The EvoLUTiosr of Twilight Sleep.

toxicants as alcohol, opium, hashish, or mescal, was
known first by primitive man, to whom also such luxuries
as tea, coffee, cocoa, and tobacco were enjoyed.

Before the discovery and the application of anaesthet-
ics, as the term is used to-day, it was the custom when
ye olde time surgeon wished to operate upon some un-
fortunate human to feed the victim plenty of narcotics,
deleriants and intoxicants. When the patient was con-
sidered in the proper state he was tied to the so-called
operating table. The operator had many assistants . .
often as many as from four to eight. They did not as-
sist at the operation itself. As is customary to-day one
or two assistants were needed in the actual work of op-
erating. But after the patient had been ' ' doped, drugged
and rendered well intoxicated" and had been tied se-
curely to the operating table, the extra assistants further
served to hold the patient. In those days, it will be
readily seen, surgery must have been crude. A skillful
surgeon was known by the speed with which he worked.
A surgeon who could remove a leg in four minutes was
a far better surgeon than one who took ten minutes.
The end results did not count. Technique and "good
surgery" were of third importance. Speed came first;
the feelings of the patient came second ; and the refine-
ments making for good work a poor third. In obstet-
rics, there being no anaesthetic to give, the women en-
dured terrible suffering.

The history of the early work of amesthesia in America
has been the subject of bitter debate for many years.
Here is no place to argue the matter pro and con but a
brief consideration of the facts will suffice. Doctor
Crawford Williamson Long (1815-1878), a graduate of
the University of Pennsylvania (1839), practiced medi-

18

TwnJGHT Bleep in j

cine at Danielsville, Ga. Dr. Long had previously noted
that ether had aniesthetic properties. These observa-
tions were purely accidental. So he gave a patient ether
and removed a small cystic growth from the back of the
neck. The experiment was successful. Later (1842-
1843) he used ether in the other cases which have been
certified and vouched for by resident physicians of his
locality. Doctor Long made no scientific records of his
uses of etlier nor did he publish any essay upon the sub-
ject. Therefore the profession has had to waive first
place in his case.

Sir Humphrey Davy of Penzance, England, in 1800
carried on a series of experiments using himself as the
subject. He experimented with nitrous oxide, which is a
gas. As a result of his work be said that "it may prob-
ably be used with advantage in Surgical operations in
which no great effusion of Blood takes place,"
• Xn 1844, Horace Wells (1915-1848), practiced dentistry
in Hartford, Connecticut. He began to use nitrous oxide
in dental work. He confided in his friend and partner
tiie results of his work. This friend and partner was
William Thomas Greene Morton (1819-1868), of Charl-
ton, Massachusetts. Even to-day an ansesthetic is not
without a certain element of risk to the patient and so
it was no wonder, in those early days of anesthesia, a
fatal case should have fallen to the lot of one of the work-
ers. It was Wells' misfortune to have had a case die
from the effects of the ansesthetic. He retired from
practice and eventually put an end to his life.

William Morton, in the meantime, had begun the study
of medicine. In those days every medical student bad a
preceptor, a physician who was recognized and who acted
as sponsor and teacher to the embryonic doctor. Mor-

J

^Po

Ill's preceptor was Doctor Charles T. Jackson, a chem-
ist of ability. He pointed out to Morton the anesthetic
effects of chloric ether. One day in July, 1844 he gave
a patient chloric ether and proceeded to fill a tooth,
Morton became deeply interested and later learned from
Jackson that sulphuric ether was also an amesthetic. So
he administered it at once to a patient and extracted a
deeply rooted tooth. After this Morton visited Doctor
John Collins "Warren, of the Massachusetts General Hos-
pital, and successfully urged him to give the new anes-
thetic a trial in surgical eases. He did not, however, dis-
close the name of the drug. The first operation took
place at the Hospital on October 16th, 1846. The case
was a "congenital but superficial, vascular tumor, just
below the jaw, on the left side of the neck." It took
Doctor Warren five minutes to complete the operation.
When the patient returned to consciousness he exclaimed,
Gentlemen, this is no humbug."

On November 18th, 1846, the discovery was announced

the world in a paper by Henry J. Bigelow. It wa3

published in the Boston Medical and Surgical Journal.

Oliver Wendell Holmes, then professor of physiology
and anatomy at the Harvard Medical School, proposed
the terms "ansesthesia" and "anesthetic", which terms
are in general use to-day.

On January 19th, 1847, Sir James Young Simpson,
professor of Obstetrics at Edinburgh, used ether in con-
finement eases. This was the first use of ether in ob-
stetrics in Great Britain. On November 4th, 1847, he
stopped using ether and in its place used chloroform.
Chloroform so impressed Simpson that he published a
paper, telling of his results, a week later.

After Doctor Simpson used an amesthetic in the case
of Queen Victoria, a controversy arose over the use of
ether and chloroform. This controversy was mainly re-
ligious in character. In a short time however the use of
anaesthetics in childbirth became the custom. It was a
giant step in the direction of better work on the part of
the doctors. "Women were spared the shock attendant
in many eomphcated cases. The doctor could wait, in
certain types of eases, and at the proper time administer
ether or chloroform, and get a living child, as well as save
the mother no end of suffering.

It was natural, therefore, that it became the custom
to administer chloroform in small doses at the beginning
and continuing through each pain, to the mother. The
small, intermittent dosage of chloroform, given in this
manner was called, "Chloroform a la reine." It had a
vogue for two generations. It had many disadvantages,
however, and in time became a rarity. But Simpson had
opened a new horizon to the physician. He had proven
that much of the pain attendant upon childbirth could be
lessened. Because of anssthesia surgical obstetrics be-
came possible. Because of anesthesia the Ciesarean sec-
tion has become commonplace among surgical operations.
Thanks to anstethesia many women are delivered of liv-
ing babies with little injury to themselves while previous
to the days of ansesthesia both mother and baby might
have died.

Since the days of "Chloroform a la reine" anffsthetiee
have been given, in many different combinations and
ways, in childbirth. And with anjesthesia in labor has
been ushered in an abuse. Before ansesthesia was uni-
versal the expectant mother was given a full test of labor

J

TcEB Evolution of Twilight Sleep. 21

before interfering with the birth. After anaesthesia be-
came the rule ia labor cases the average physician saw
in it a saving of time, instead of giving a patient the
full test of labor, in his eagerness to save time, many
doctors administered chloroform or ether and delivered
the child with forceps. Often the indiscriminate use of
forceps wrought great injury to the child and rendered
the mother a physical wreclt. And so to-day the skilled
worker in obstetrics is guarded and careful in hie use of
forceps for, full well, he knows the dangers attendant
upon their apphcation.

Anaesthesia, however, soon became the custom only in
cases reqmring surgical interference. By this I mean
the application of forceps, manipulations changing the
position of the child and thereby making a normal birth
possible, and in major operations, such as a Ciesarean
section, etc. It was observed that in long, drawn out
cases, the woman in her efforts to give birth to her off-
spring, often suffered uimecessary pain. The pain was
not in proportion to the contractile power of the womb.
The muscular contractions of the womb became feeble
but the pains stiU continued in their severity. To meet
this condition it became the custom to administer to the
patient a narcotic, such as morphine or chloral. It was
learned that the patient fell asleep or experienced a
needed rest, the uterus later contracted with the desired
force, the cervix (neck of the womb) more easily dilated,
and in many cases a normal birth resulted. Some physi-
cians went further than this. They made a routine of
giving the patient chloral or morphine, and injecting
atropine into the cervix, in slow labors. This gave the
womb a rest and made the neck of the womb more easily
dilatable.

i

Twilight Sleep in Ameeica.

ince the days of "Chloroform a la reine"
been a universal custom. If, after the use of morphine or
chloral, or some other drug, a certain time passes and
the child is not horn, then an anesthetic is considered
and given, in the majority of cases.

Pain in childbirth still continued the dominant factor,
however, although an anesthetic or a narcotic was given.
Like the primitive people or the women of savage tribes,
here and there, would be and is a woman who either suf-
fered little or no pain or else did not appreciate the pain.

Every woman knows, who has borne children, and
every doctor knows who has attended confinement cases,
that it is the dread of pain and the memory of the suffer-
ing attendant upon childbirth that makes it a dreadful
ordeal.

Then the last crowning achievement in the art and
science of obstetrics became a reality.

The psychology of the evolution of Twilight Sleep we
may never know. Possibly it was due to a combination
of past events. The discovery and use of anesthesia,
the administration of quieting drugs, . . these factors
play star roles in the evolution of this last triumph.

After years of patient labor and persistent experi-
mentation, it was found that scopolamine and morphine,
used in definite doses, regulated according to the case at
hand, caused a diminution of the pains of childbirth, but
better still, caused an apperception of pain. Twilight
Sleep, successfully administered, is really the lack of
memory of pain.

The first to test this method in childbirth was Dr. Von
Steinbuchil, at the time connected with the Freiburg
FrauenkUnik. Later Bernhardt Klronig, a gynecologist

The Evolution of Twilight Sleep. 23

of Jena, with Dr. Karl Gauss, perfected the technique,
now followed.

It is to these men and their associates, that Twilight
Sleep has been perfected and to them that we have defin-
ite rules to work by and a technique, in detail, whereby
in America and elsewhere it may be successfully given.

Twilight Sleep in Amebica.

I

Twilight Sleep.

if an advertiser had been seeking a fit term for a brand
of goods, in order to advertise them, he could not have
been more successful than were our German friends in
choosing the term, * ' Dammerzustand " or " Dammer-
sohlaf". "Daminerschlaf" was not the result of long
cogitation but describes the state of the mother while in
labor. This idiom inaecurately translated into English
has been termed "TwiUght Sleep". It has become uni-
versal. Better than any other phrase it describes, in a
terse way, the whole condition.

A mother in the "Twilight" state is neither conscions
nor unconscious. She is not really in a state of semi-
consciousness, although this is about the condition pre-
sented. It is a sort of between darkness and dawn state.
The mother, as a rule, falls asleep between her pains.
During the pains she seems conscious and gives express-
ion to her suffering the same as any woman not in the
"Twilight" state. If the patient remains in a deep
sleep and gives no evidences of feeling pain she is too
far under the influence of the drug. This condition is to
be avoided. It is a dangerous condition both to mother
and child. But of this we will speak later on.

Two drags are used to produce the state of the mother
known as "Twilight Sleep", They are Scopolamine and
Morphine.

Twilight Sleep. 25

There is no "secret" to the technique of administer-
ing these drugs. But the operator must possess a sixth
sense, either inherent or acquired, and know his case.
There is a formula for the amounts of the drugs to be
given and at what intervals of time to administer them.
This formula has been devised by the patient workers at
Freiburg and found to suit the average case. Every
case, however, is not the average. One woman will re-
■quire twice as much of the drugs as the next woman and
that woman but half the dosage of the first woman.

Up to the present the German preparation of the drugs
has given the best results. It may be that by the time
this is before the reader the American chemists will have
produced a still better preparation. It remains a fact,
however, that by those who had success in the first cases
of "Twilight Sleep" in America, the German prepara-
tion was used. The failures, and they were in no small
number, have been ascribed to other preparations.

In order to get a clear idea of "Twilight Sleep" an
ideal ease delivered by this method will be cited.

The woman entered the hospital at 8 a.m. She was
an American by birth. Temperament nervons. She had
read of Twilight Sleep and had been admitted to the ma-
ternity ward asking, if possible, to have that method used
in her case.

She had had one child. It was bom dead. She had
a keen recollection of the suffering she endured in that
first case. She described it as a living purgatory. She
prayed she would never again become pregnant. When
she realized that she was to have another child she nearly
became "crazy". "With the apprehension of future suf-
fering her mental state was beyond description.

I

t

I

26 Twilight Sleep in Ambeica.

And so she entered the hospital hoping against hope
that all she had read of Twilight Sleep was true.

She was admitted to a small room in a quiet corner
of the building. She removed her clothes and donned a
dressing sack. She was not put to bed. Her pains were
feeble and occurred at long intervals.

The house doctor took her measurements, history, and
a complete physical examination was made. There being
no reason discovered why she shouldn't be "Twilighted"
she was told that she would have her baby in good time,
that it would be a normal case unless the unforeseen hap-
pened, and that as soon as her pains became "real" the
visiting obstetrician would be called and the first injec-
tion of the drugs given.

About twelve thirty o'clock, noontime, she was having
fairly strong pains.

She was put to bed. The room was made as sound-
proof as was possible. Beyond being told to have no
fears for the future nothing further was said to her.

The visiting obstetrician ordered the first dose of Sco-
polamine and Morphine given. These are given sepa-
rately. These drugs are in solution and are adminis-
tered hypodermically. They are injected in the thigh
near the hip.

In a short time the patient complained of great thirst.
The Scopolamine causes this condition. Water was
freely given throughout the entire case. Food is with-
held, however, while in the Twilight state.

In about fifteen minutes she said she felt drowsy.
Shortly after she fell into a light sleep. She was easily
aroused. By calling her by name, in an ordinary con-
versational tone of voice, she would open her eyes and
answer. Her face was flushed.

When she felt a pain she compressed her lips and
moaned feebly or tossed about in the bed. Under ordi-
nary conditions a woman of this type would have
screeched with the pain and begged the doctor to "do
something". In this case as soon as the pain ended she
closed her eyes and was again in a light sleep. At times
she opened her eyes and asked for a glass of water.

At stated intervals injections of Scopolamine were
given. The Morphine is used with the first injection but
not repeated for several hours, as a rule. Some only
give it once. It depends on the case at hand.

As the labor progressed and the nterine contractions
became stronger she gave expression more forcibly to
the pain.

Several physicians were in attendance, seeing "Twi-
light Sleep" for the first time. When the patient would
moan and ask such queries as, * ' How much longer ? " "Is
it nearly over?" these doctors were seen to exchange
meaning glances and the operators knew that their faith
in "Twilight Sleep" was waning fast.

"Is this the real state of Twilight Sleep!" one physi-
cian asked. He was given an affirmative answer.

"Then what benefit does the patient derive?" asked
another.

"She loses the memory of all preceding pains. She
is living only the present moment. Impressions beyond
twenty minutes are blanks," was the answer given.

And so a series of memory tests were given. These
memory tests are the crux of the situation. She had
been examined four times. When asked how many
times she had been examined she mumbled, "One, I
think."

28 TwnjGHT Sleep in Ameeica,

"How long have you been in this rooml" she was
asked

"About half an hour."

8he had entered the room at 8 a.m. It was then
nearly six p.m.

At 8.20 p.m. she gave birth to a live male baby weigh-
ing seven and three-quarters pounds.

Purposely many things that make for a successful case
have been omitted in this report.

Near the end, to the experienced physician in obstetric
work, she resembled a normal ease. She cried out with
the pain and begged to be relieved. As soon as the pain
ended, however, instead of giving the appearance of
complete exhaustion, she fell asleep and remained quiet
until the next pain awakened her.

With the birth of the head she was given a light ames-
thetic. Some make it a routine to give an anesthetic aa
the head is bom. Some dispense with this routine. In
this case a few drops of ethyl chloride were g^ven, using a
specially devised mask.

The baby cried as soon as it was bom. It was not
blue. It looked as pink and robust as a baby bom under
perfect conditions by the "Old Method,"

The mother was made comfortable. The baby was re-

I moved, at once, to the baby ward. It has been learned
that the sudden cry of a baby, after birth by the "Twi-
light Sleep" method, often is heard by the new mother
and is the thing that remains in her memory.
Three hours later the mother was awake and aU effects
of the drugs had worn off. She was conscious. She
asked when the baby would be born.
A nurse told her that they expected the baby in two
or three hours.

I

Twilight Sleep.

"What makes it so dark?" the mother replied.

"It is after midnight", the nurse replied.

The patient seemed bewildered. She passed her hand
over her abdomen. A hopeful light came into her eyes.

Lookiiig expectantly at ibe nurse, she asked, "Is it
true!"

"Of course it is," from the nurse.

"What is it?"

"A boy — Now, don't ask questions, but go to sleep."

Do not form the impression that every case of "Twi-
light Sleep ' ' has such a perfect ending.

In Germany it has been reported that an average of
from 60 to 80 per cent of the cases are successfully twi-
lighted.

After a sufficient amount of the drugs have been in-
jected and the operator appHes the memory tests and
finds that the patient has not responded to the drugs, no
further injections are given. This type of case is not for
Twilight Sleep.

The practiced obstetrician who has had experience
with these eases must use his judgment as to the dosage.
Too much of the drug may cause endless harm. Too
little of the drug given, or given at long intervals of
time, cause what are termed, "isles of memory." These
"isles of memory" are to be avoided. To give an ex-
ample of the meaning of this term. The patient has
been in labor two and a half hours. She has had one in-
jection of Scopolamine and one injection of Morphine.
Three quarters of an hour later she responds to the men-
tal tests. The operator knows that the patient is re-
sponding to the drugs and in the proper state of Twi-
light Sleep. But the effects of the drug wear off and
suddenly she appreciates her true state. The operator

rwHJGHT HLBBP IN

Ambi

realizes that she has "come out from the effects of the
drug" and orders further iujections. From then on the
patient has no memory of what takes place. After all is
over she will retain the memory of what took place houra
before while not under the influence of the drugs. The
fewer these "isles of memory" the more successful the
case. If a patient is not "Twilighted" successfully she
will have many of these "isles of memory" and later on
patch them together, making a "whole carpet" of the
pieces, and declare she knew all that transpired.

From reports we know that there is no average time
for a ease of Twilight Sleep. Some cases have not lasted
two hours. We know of, at least, one case that was kept
in the Twilight state twenty-nine hours. This case was
successful.

Although a patient may be the proper type for Twi-
light Sleep and physically there are no contra-indica-
tions to this method, it does not follow that the birth will
result in a normal one.

This the public has been led to believe through maga-
zine and newspaper accounts. Malpositions of the foe-
tus in utero (child in the mother) have to be met and
remedied the same as in a case not conducted according
to the methods of Twilight Sleep. Versions, forceps,
breech extractions . . all are possible and cannot be
avoided.

It is true that there are certain distinct advantages of
this method besides the lack of appreciation of the
memory of pain. But these will be considered in another
chapter.

To have a successful termination of a Twilight Sleep
ease certain refinements must be followed.

TwnjQHT Sleep. 31

. bright light must not shine in the patient's eyes.

The patient must not be exposed to external irritation.
All lights in the room should be subdued and shaded.
Some operators, in order to make sure on this point,
have the patient wear colored glasses.

Unnecessary or sudden noise is to be avoided. For
this reason the nurses and doctors wear rubber soled or
felt shoes. In order that no noise disturb the patient,
and so cause an "isle of memory", oiled cotton is placed
in the patient's ears.

Soon after Twilight Sleep was practiced in this coun-
try the question as to whether it could be successfully
carried out in a patient's home became subject to debate.

It was urged upon the profession that all Twilight
Sleep cases should be reserved for a hospital. The rea-
son for this is obvious. A Twilight hysteria was sweep-
ing the land. Every pregnant woman was calling on her
physician asking about painless childbirth and no few
demanded to be delivered a la Twilight.

Twilight Sleep was on trial. Reports of repeated un-
successful cases meant that Twilight Sleep would be
doomed. The specialist wanted to avoid this and give it
a fair, scientific trial.

Doctors flocked to maternity clinics eager to see a
TwiUght case. Many bought the drugs and feeling se-
cure, that in the near future they would be experts, en-
gaged Twilight Sleep cases in their private practice.

Guarding against failure by the inexperienced it was
preached that the only place for a Twilight case was a
well equipped hospital.

To name the hospitals in which Twilight Sleep eases
have been conducted would be to list every important
hospital in the country.

Twilight Sleep having been tried and found successful,
the specialist began to extend his work to include cases
conducted in the patient's home. To-day, hundreds of
physicians are skilled in the art of this method, and to
the profession, a Twilight ease excites but a passing in-
terest.

A well equipped institution is the ideal place for any
pregnant woman to give birth to her child. Alas the
ideal is not always possible. Many live far from, hos-
pitals or feel that they can eeomonize by remaining home.
For the ordinary case this is good and well. The pa-
tient and the physician should think twice, though, before
deeiding to have the lying-in room in a private dwelling
in a case of Twilight Sleep.

Twilight Sleep, at the present, is for the very poor or
the rich. In large cities the poor can have free board
and the attendance of experienced obstetricians. They
get the benefit of the latest and best methods. Hospitals
are always open to them.

The wealthy get no better attention. Certain luxuries
are within their means. In hospital work these luxuries
are the only difference between the two extremes of so-
ciety.

It is of the great middle class that the obstetrician
most often comes in contact.

Unless the patient (one of this middle class) can af-
ford to engage a trained nurse, or possibly two at the
time of the delivery, Twilight Sleep should not be at-
tempted in the home. A tenement is no place for the
successful handling of a case conducted according to this
new method.

As a rule the patient who can afford to engage a physi-
cian to give Twilight Sleep has the means to engage

trained nurses and lives in surroundings that may be
adapted to this method.

A busy obstetrician cannot practice cheap Twilight
Sleep. Unlike the average case he cannot see the pa-
tient and then leave giving instructions when he is to
be called. Once he begins a Twilight Sleep case, either
he or his assistant, must be in constant attendance. The
time in all obstetric cases cannot be foretold. And so it
happens that the doctor remains with the patient for
many hours. Naturally he must be compensated for this
time. No branch of medicine is more poorly paid than
that of obstetrics. People who gladly pay a handsome
fee for a simple, uncomphcated case of appendicitis op-
erated on, grudgingly pay a sixth or an eighth of that fee
for an obstetric delivery. For this reason the general
practitioner has not taken kindly to Twilight Sleep. The
specialist who has demanded and is paid a fair compen-
sation for his work naturally comes in contact with the
class of people who make it possible for him to spend the
slowly passing hours on a Twilight Sleep case.

This is an unfortunate economic condition, but is true.
In towns and cities the average woman of small means is
in better hands in a hospital, especially if it be her first
baby, than engaging a doctor whose main idea is to "get
the case over with", collect a few dollars, and leave the
damage done to a future date and a different physician.

k

34

Twilight Sleep in America.

Twilight Sleef^Pbo and Con.

A well known obstetrician speaking before a large aud-
ience was asked as to the dangers of Twilight Sleep. He

answered: "I have been asked to discuss the dangers of
Twihght Sleep, but I cannot do that for I know none.
There should be no danger when competent physicians
and nurses are employed. All drugs contain poison, but
I have not seen a single untoward symptom in any of
more than 250 cases with which I have had experience."

This, from an authority, is true of other workers.
I "What are the objections to Twilight Sleep?

I will not discuss whether God intended women to suf-
fer during childbirth. Science does not deal with the
sentimental. It treats of facts. Suffice to impress the
fact that there are some women who suffer Uttle or no
pain during their delivery. This is also true, as a rule,
among the women of savage tribes, as we have learned.
If God decreed that women should bear their offspring
with pain, why are certain women excluded from this
general rulef

Twilight Sleep — Pbo and Con. 35

Civilization, not nature, through the evolution of long
periods of time has changed women from simple into
complex beings. And with this change pain has become
a factor in labor cases.

It is dangerous to the mother.

A common objection. A man with a broken leg is suf-
fering great pain. The doctor in charge gives the patient
a dose of morphine. The pain is lessened. Where is
the danger ? In an over dose 1 Naturally. The same is
true of the drugs used to produce the state known as Twi-
light Sleep. Gfive too little and there is no effect. Give
too much and the patient and baby may be placed in a
dangerous condition. Therefore if used by a competent
physician this danger is overcome.

It is dangerous to the baby :

A most serious objection. As a matter of fact the
records of thousands of cases of babies bom at Freiburg,
Germany, by the Twilight method, show that the infant
mortality is decreased.

From reports of American physicians, using this
method, the results show that there is a decrease in the
number of babies born dead or dying shortly after birth.

Babies were bom dead long before "Twilight Sleep"
was ever thought possible. Many conditions make for
dead babies as, syphilis, long protracted labors, eclamptic
convulsions of the mother, hard forcep deliveries, the pla-
cental cord getting into a knot or twisting itself about

36

TwiLiOEX Sleep if Amebica.

the child's neek, hard breech deliveries, etc. These are
some reasons why babies do not live.

In other countries, Germany especially, when a baby
is born dead an autopsy is made. From this work it has
been learned that many conditions cause death of the
child at birth or soon after birth. Among causes of
death may be mentioned, lack of certain vital organs, dis-
placement of organs, internal hemorrhage, or some con-
dition over which man has no influence. Therefore Twi-
light Sleep or the doctor in charge should not be held re-
Bponsible for the death of the baby.

Before the advent of Twilight Sleep these facts were
recognized and appreciated. Since Twilight Sleep, its
opponents place the blame of every still-birth on this
"new foreign method."

It is true that a too large dosage of the drugs may
cause the death of the fcetus, or cause it to be bom blue
and therefore hard to resugitate. But the Twilight meth-
od properly carried out gives as good end results to the
child as when it is not used.

It makes dope-fiends of the patients 1

This is a far fetched objection. It is admitted that
doctors giving their patients "dope" on all and every
occasion have made "drug fiends" in many instancea.
The use of morphine and cocaine has been responsible
for this state. In Twilight Sleep, however, the patient
-Ass no memory of any but the first injection. AH anbse-

i.*

TWTEJOHT Sleep-^Pho ahd Cott.

quent injections are not appreciated. Does it seem likely
that the new mother after the birth of the child, will
erave a drug which causes nothing but lack of memory!

'^Women are made insane from the drugs !
'ne morning this statement was made in a New York
paper. A prominent physician was quoted. Invited to
attend a meeting of a medical society to discuss the sub-
ject, he was unable to attend, but sent a letter denying
that he had ever made the statement that Twilight Sleep
caused insanity.

That there is a type of insanity that follows or accom-
panies child-birth is known. Every obstetrician has met
with these cases in private and hospital practice. I have
been unable, however, to find record of a single case of
puerperal insanity claimed to have been caused by either
of the drugs used in Twilight Sleep.

Every objection to Twilight Sleep has been met and
answered. It is known that xn proper surroundings, un-
der the care of competent nurses and attended by skillful
physicians the dangers attendant on Twilight Sleep be-
came nil.

The advantages are many. The lessening of the im-
mediate pain, the wiping out of the memory of the suf-
fering just past and the fear produced by it, naturally are
its chief advantages.

It prevents the offensive use of forceps. A physician
better appreciates this statement. Forceps are a neces-

38 Twilight Sleep in Amekica.

sary evil. They have their place and rightly used are a
blessing.

No greater abuse has been practiced in the practice of
obstetrics, than the faulty use of forceps. If it were not
for the obstetric forceps the gynecologist would lose half
the field for his work. A competent worker never abuses
the use of his tools. Unfortunately many physicians are
not skillful when they enter into the domain of surreal
obstetrics. A delivery of a child with medium or high
forceps is a surgical procedure.

Forceps save time. Rather than remaining with the
patient two or three hours the doctor can use "instru-
ments" and be on his way in, possibly, half an hour's
time.

The result of this abuse is laceration. The neck of the
womb is torn. The outlet of the birth canal is lacerated.
This means a major operation sometime in the future. ,

Any object introduced into the womb from without is
liable to carry with it infection. Even in cases where the
strictest asepsis is observed blood-poisoning, after the
use of forceps, may result.

To be successful in eases of Twilight Sleep the opera-
tor must be competent. Such a man is not likely to
"spoil" his case by running unnecessary risks. A pro-
fessor in one of the Eastern Medical Colleges is responsi-
ble for the statement, "If Twilight Sleep does notliing
^L else it will curtail the indiscriminate use of forceps." l

I

Twilight Sleep — Pho and Con. 39

"it has been observed that in cases of Twilight Sleep
there is no sudden expulsion of the head of the child.
The process of birth is gradual. The maternal parts
have time to accommodate themselves to new conditions

and lacerations are lessened in severity and in number.

In eases of pregnancy comphcated by heart disease
Twilight Sleep is a distinct advantage. A physician lec-
turing on Twilight Sleep before an audience of a thou-
sand women was asked by a woman in the audience
whether Twihght Sleep was suitable for women suffering
from heart disease.

"There are no cases," he said, "in which Twilight
Sleep can be used with less danger and with more bene-
ficial results than in that of women suffering from heart
trouble. The great danger to women with heart trouble
is the effects of shock and exhaustion, which are both
greatly diminished by Twilight Sleep."

In certain types of cases of toxemia of pregnancy it has
been claimed that Twilight Sleep lessens the severity of
the sequalffi. In the severe eases this is not held to be
true. In fact it has been listed as a contra-indieation.

The statement has been made that due to the lessening
of shock to the nervous system Twilight Sleep mothers
have richer and more milk I

Later on we will see that Twilight Sleep babies, in 47%,
have gained weight at the tenth day due to better feeding.

^V 40

^H It is true that the women post-partum are in better
^H condition after having been Twilighted than are those
^^1 ■women who have delivered without Twilight,

^H A well known obstetrician, who had never seen Twi-
^1 light Mothers after the birth of the baby, was being eon-
^1 ducted through the maternity ward in a hospital.

^H He was shown the "Twilight" mothers — "The fact
^H that impresses me," he remarked, "is that these women
^H look so fresh. They do not give the appearance of women
^H who have gone through labor."

^H The shock to the nervous system having been reduced
^H to a minor degree, Twilight Mothers, a few hours after
^H the birth of the child, are none the worse for their esper-
^H ieuce.

^H The drugs have no effect on the contractions of the

^H womb. Bleeding post-partum is not so likely to happen

^" and some physicians allow their patients to get out of

bed on the third or fourth day. Some even permit this

the day of the dehvery. This is given as a matter of in-

I formation and need not be discussed in these pages.
There are definite contra-indications to the Twilight
Sleep method in obstetrics. The very young and the very
aged should not be twilighted. This rule has been disre-
garded without serious consequences.
In cases where the pelvis of the mother is deformed,
or where the doctor knows a surgical operation surely
will be necessary, Twilight Sleep is out of the question.

Twilight Sleep — Peo Am) Con.

The hemorrhages of childbirth place the mother be-
yond the pale of Twilight Sleep.

Twilight Sleep should not be attempted in cases where
a diagnosis of a dead fostus in utero has been made. The
friends and family would be liable to blame the death of
the child to Twilight Sleep.

A well known obstetrician has defined Twilight Sleep
as the application of partial narcosis to the most painful
ordeal in a woman's life, in such a way as to eliminate
the memory of subjective pain without interfering with
the uterine (womb) contractions. A great many doctors
have referred to this as the best definition, yet given, of
Twilight Sleep.

Going over the vast amount of literature upon this sub-
ject, and most of it of recent date, the author will give
short abstracts of the most important phases of this
topic, as presented by these authorities.

One writer says that the partial narcosis method of
making the sufferings of childbirth less and in making it
easier for the neck of the womb to dilate has been ef-
fected for a great many years by the drop chloroform in-
halation at the beginning of each pain, by injecting a full
dose of chloral in the bowel and in administering mor-
phine or one of the opium preparations. These methods
have been a blessing especially to those neurotic women
who cry aloud for help in this period when external in-
terference should not be attempted except in the face of
a grave complication. Every physician knows that these

42

Twilight Sleep in Amebioa.

women tempt them and, the doctor weary with waiting
and watching and exhausted from the loss of sleep,
against his better judgment goes to these unprepared
parts and the result is chronic invalidism and gynecologi-
cal surgery in the future.

The statement has been made that it is possible to re-
move the suffering of childbirth in about 85% of all

When scopolamine and morphine are used the neck of
the womb dilates more easily. In the face of a dry labor
(after the rupture of the membranes) tills dilation is
more marked.

A woman in the Twilight Sleep state exerts less muscu-
lar effort.

That the nervous shock is eliminated and that these
women feel and look much better than after an ordinary
labor has been demonstrated in thousands of cases.

The contraction of the womb and adjacent structures is
more rapid after a Twilight Sleep case as has been
learned from the experience of many obstetricians.

It was through public interest, aroused in the lay press
and an American Magazine, that the medical world was
forced to investigate the work of Kronig and Gauss.
Many doctors from America journeyed to the little town
by the Black Forest. The result has been the present ex-
cellent work by American doctors with Twilight Sleep
cases.

Twilight Sleep — Pbo anb Cok. 43

Inasmnch as studies show that it i8 possible to lessen
the pains of childbirth and to cause a forgetfulness of
what pain there was in about 857o of the cases in which
the Twilight Sleep method was employed, it is the conten-
tion of many men that a woman is entitled to the relief
of pain during labor, if it is possible for her to be Twi-
lighted, provided she is exposed to no undue risk or the
unborn child is not liable to harm.

A professor of obstetrics claims that after twenty
years of consultation work in New York he is of the opin-
ion that labor is anything but a normal and physiological
process. He claims that over 50fo of all gynecology
(diseases of women) is the result of badly conducted nor-
mal labor. To his mind poor diagnosis in confinement
cases is more frequent than in any other department of
medicine and surgery, except perhaps cancer.

The fact that there are dead and mutilated babies, or-
gans torn and puUed out of place, chronic invalidism and
infection, are named as some of the causes which have
produced the great public demand for Twilight Sleep.

One doctor says that it is especially indicated in ner-
vous women in their first labor. These are the women
who, as a rule, are given an anaesthetic and delivered
with forceps. These "physically unfit" are benefited by
scopolamine and morphine.

44 Twilight Sleep in Amebioa.

There is no better way to end this chapter than to
quote a doctor who has had a large experience with Twi-
light Sleep in America. He said, * * The more I see it the
more I am impressed by it. To me Twilight Sleep is a
reality. ' ^

The Futtjee and Twilight Sleep.

The Future ahd Twilight Sleep in America.

So many facta were learned by American physicians
about Twilight Sleep during the first few months, it is
difficult to foretell what the future will bring forth.

It was learned that smaller doses of the drugs would
give as satisfactory results as the dosage recommended
by the German workers. Early in the work it was
thought that speciaDy equipped wards and delivery-rooms
were essential. As this would take time and money the
early cases of Twilight Sleep were conducted ia the pri-
vate rooms of the hospitals. They were successful. A
room removed from the noise of the streets and away
from the noises of the building was found to answer all
purposes.

In Germany the nurses, specially trained, administer
the drugs and notify the attending physicians at certain
times regarding the progress of the case. In America
sufficient time has not passed to instruct the graduate
nurse or the nurse in training to do this work. Many
hospitals are working along these lines, however, and in
time there will be many nurses competent to handle these

^

I

I

Twilight Sleep in America.

cases. Until that time the doctor in charge will continue
to do all the work.

In America the dosage, the symptoms, the indications
for and the contraindications, have been standardized
and in many hospitals the internes (house doctors, ns-
ually recent graduates) conduct all but the private cases.
These internes, in a few months, enter the actual prac-
tice of medicine. Having been schooled imder the direct
supervision of the attending obstetricians, as soon as they
begin the actual practice of their profession they will be
skilled in the art of Twilight Sleep. These men, the men
who visit clinics to learn the Twilight Sleep technique,
and the visiting obstetricians of the hundred of hospi-
tals of America, will number into the thousands. And so,
unless a better method is devised, Twilight Sleep will be-
come the routine method, in cases in which it is indicated,
in America.

A prominent obstetrician and gynecologist before an
audience of doctors said that he had gone twice to Frei-
burg. He said that from his close contact with Profes-
sor Kronig and Dr. Gauss he had received some very def-
inite impressions. About two years ago some physicians
attempted this method but with poor results. Since then
the workers in Freiburg have perfected the method. He
warned the profession to remember that many fake
cures had been fostered on the American public through
newspaper hysteria, but in the case of painless labor it
was necessary for the expert to give it a fair trial before
Hie profession, as a whole, should attempt it.

The Future and Twilight Sleep. 47

He ended Ms long discussion by saying that to his
mind Twilight Sleep marks one step further toward the
obstetric inevitable. He urged that the doctor with spe-
cial obstetrical training was the only one who should at-
tend a primipara. (Woman with her first baby.)

Since Twilight Sleep was introduced in America it has
not been an infrequent experience to hear of certain set-
tlements where the doctors for years have practiced a
form of painless childbirth. Upon investigation these
facta cannot be substantiated.

Another fact that has been given space in the news-
papers of the country, is that there are better drugs or
combinations of drugs to induce the Twilight state than
the accepted Scopolamine and Morphine. Physicians
have had formula of drugs published and have claimed
that, for years, these drugs have been used and with suc-
cess. A book of this sort is not to debate such ques-
tions. All these doctors claim may be true. It is a rec-
ognized fact among physicians, however, that the one
who first publishes a new method, gets the credit for the
method. We have known about Twilight Sleep for years.
If a physician has practiced a method of his own for
several years and found it successful, this is a late day to
rush into print and seek glory for himself and bis own
method.

The majority are of the opinion that it is better to try
out one accepted method and master it before experi-
menting with untried methods.

i

48 Twilight Sleep in Amebica.

Will the present method be improTedt It is a preva-
lent opinion that it will be bettered, rendered safer, easier
to give, and within the province of the physician of all
degrees of training to practice Twilight Sleep in his work.

From France a new and a better method is claimed.
One American obstetrician has given this method an in-
different trial and reported his results, which were satis-
factory, in a prominent medical journal.

On July 21st, 1914, Professor Eibemont Dessaignes of
the French Academy of Medicine delivered an address on
painless childbirth.

In 112 labors he used a morphine preparation, the dis-
covery of a chemist, George Paulin. Paulin and Doctor
Pierre tried the new drug on animals and finding it safe
recommended it to Eibemont. In his report 84 cases
were in a state of complete analgesia, 24 cases in marked
but not complete analgesia and 4 patients claimed no re-
lief. The analgesia lasts from 30 minutes to 12 hours.
Sixty three cases needed but one injection. Thirty-nine
became painful at the end of five hours. Nine cases re-
quired three injections. One case was injected five times.

Of 112 labors 115 babies resulted. Seventy-seven cried
at once. Twenty-eight were "dazed" at birth. One was
bom dead.

It has been hard for American doctors to get this drag
and little or no work with this preparation has been at-
tempted in America. Therefore we must withhold judg-

The Futube and Twhjght Sleep. 49

ment until a future time when this ideal method, if all is
true that is claimed for it, is thoroughly tested by Ameri-
can experts.

Many women have asked their doctor: "If your wife
was to have a baby would you encourage Twilight Sleep?"

This is a test question. It strikes at the heart of the
situation. Many doctors of fine balance, in their enthu-
siasm, are liable to practice methods in their routine hos-
pital work that they would hesitate using on one of their
own.

Therefore the writer asked this question of physicians
whose knowledge and experience with Twilight Sleep
made them competent of giving a satisfactory answer.
All answered the question in the affrmative. The sum
total of their answers were, "It's safe. It's practical.
"Why not f"

A Brooklyn doctor wrote to the more prominent obstet-
ricians throughout the United States asking them to fill
out an enclosed blank on their work on Twihght Sleep.
From some thirteen hundred eases reported he tabulated
one thousand cases and for comparison took hospital rec-
ords of a thousand cases delivered by the usual methods.

The figures presented by this physician are of vital in-
terest. The writer would like to refer to this doctor by
name as the statistics he has given to the medical world
have had a great influence on Twilight Sleep in America.
As the author has made it hie rule not to mMitaqn _tiy-.

50 Twilight Sleep ik America.

name any American doctor in this book, much to Ms re-
gret, he must adhere to his rule in this case.

This doctor reported that of the 1,000 cases not Twi-
lighted, 392 were of women having a baby for the first
time, and the balance, 608 were women who were already
mothers.

A woman about to have her first child is called a primi-

para. A woman who has had children is known as a mul-
tipara. Hereafter we will nse these terms.

Of 1,000 women who had babies in America by the Twi-
light Sleep method, 698 were primpara and 302 multi-
para.

Reports showed that of the Non-twilight Sleep cases
73.9% of the primipara had spontaneous labors. 86.1?^
of the multipara were spontaneous births.

Of the 1,000 Twilight Sleep eases 78.36% primipara and
89.73% multipara had spontaneous deliveries.

What do these figures mean?

They show that of the primipara about 5% and of the
multipara about 3% more of the Twilight Sleep cases had
natural deliveries and without the aid of instruments.

Turning to the cases that required operative interfer-
ence the Non-twilight Sleep primipara averaged 26.1%
and the multipara 13.9%.

The Twilight Sleep cases resulted in 20.9% of priim-
para and 10.27% multipara who required operative
. measures; : -■ : ;

The Futttrb and Twilight Sleep. 51

ihese figures show that comparing 1,000 cases of each
method the Twilight Sleep cases have a lower percent, of
surgical interference.

We now arrive at still more interesting figures for they
deal with much that has filled page after page of the
newspapers and been the cause of endless contention and
fruitless discussion.

Of 1,000 cases of Non-twilight Sleep cases one case died
on the tenth day. There was not a death reported of the
1,000 Twilight Sleep cases.

We have read much of insanity caused by the Twilight
Sleep method. One case delivered normally (not Twi-
lighted) was melancholy on the sixth day. One Twilight
Sleep ease (of the 1,000) gave evidences of a depressive
melancholia. This means that the Twilight Sleep drugs
have no mental effect on the patient. Out of a clear sky
a woman before or after the birth of her baby may sud-
denly go insane. This has been the experience of obstet-
ricians for many years. Puereperal insanity it is termed.
If figures mean anything we can readily see that scopo-
lamine and morphine do not produce this condition.

Bleeding after the birth of the baby, a serious condi-
tion and often resulting in death, showed 1.7% in the
Non-twilight Sleep cases and .%% in the Twilight Sleep
cases. Many doctors have claimed that the drugs used
to induce Twilight Sleep make post-partum hemorrhage
more likely. These figures disprove this contention.

Tears or lacerations resulting from childbirth mean a
great deal to mothers. All lacerations of any ay^recvar

i

I

I

ble degree call for surgery. The reports of 1,000 eases
of deliveries not Twilighted in the primipara showed that
91% suffered lacerations. Dwell on these figures. Of
the multipara 46.9% suffered fresh or added lacerations.
Of the 1,000 women of America who have had Twilight
Sleep 25.1% of the primipara suffered lacerations and the
multipara 3.28%.

Therefore 68.9% of the cases not Twilighted suffered
lacerations, wliile 14.2% of the Twilight Sleep eases were
lacerated. This difference (54.7%) shows one great ad-
vantage in favor of Twilight Sleep.

Eighty-six per cent of the Twilight Sleep cases had a
PAINLESS LABOR.

Of the babies bom by both methods the infant mor-
tality was decreased 10% in Twilight Sleep eases.

After the birth of the baby the following figures are of
interest :

WITHOUT TWILIGHT BLEEP. TWILIGHT SLEEP,

Spontaneous Cry. ...78.6% 79.9% (Increase)

Oligpncea 5.8% 14.6%) (Increase)

Asphyxia 3.6% 3.6% (No difference)

Still birth 2.5% 1.9% (Decrease, but

in all fairness these still-birth figures have little mean-
ing).

Of 951 babies bom of Twilight Sleep mothers 454 of
this number had gained in weight on the day the mothers
Hne discharged.

The Futube and Twilioht Slbep.

53

Some say figures have no value. To these, scientific sta-
tistics have no meaning. The only way we can compare
Twilight Sleep eases with those not Twilighted is by tak-
ing hundreds of cases and showing percentages. To the
fair minded the preceding figures all speak well for Twi-
light Sleep. Other doctors are tabulating figures and in
the near future, probably by the time this small book is
published, five thousand or more Twilight Sleep cases will
have been reported. These figures, however, that the
Brooklyn doctor has given to the medical world are the
first to date that have been tabulated of the Twilight
Sleep cases in America.

Prom an economic standpoint Twilight Sleep means
more babies. The more intelligent members of our pop-
ulation are the ones who, througli the fear and dread of
bearing children, practice race suicide. These are the
women who should have large famiUes. Once Twihght
Sleep becomes the custom these women, now sterile from
choice, will do their part in populating the earth.

A Cleveland doctor, noted for Ms work on shock, has
shown that violence, insomnia, and anxiety are three
great contributing factors in the production of shock.
Twihght Sleep has a tendency to ehminate insomnia and
anxiety. As we have learned, the mother also escapes a
disagreeable experience, and all violence in connection
with the birth of the baby is banished from her memory.

A doctor speaking before the New York Academy of
Medicine said he had gone to Freiburg rather prejudiced

M

164 Twilight Sleep hj- America.

against TwiKght Sleep, but that he was rapidly converted
and had become very enthusiastic, and the enthusiasm
of the women who had received the treatment would
rapidly convert one to champion its use.

The following is quoted from a paper published in the
Medical Record, issue of January 23rd, 1915: "I flrmly
believe this (Twilight Sleep) treatment of labor to rank
as one of the greatest advances in medicine, as well as
one of the greatest boons to the race, largely because it
promises for a better race."

The lay-press has written of cases of major operations
performed by the Twilight Sleep method. The public
asks if this is possible.

It is . . but the method is far from new. In fact, the
use of scopolamine and morphine in surgery antedates
the Twilight Sleep method as related to obstetrics.

A paper was published in 1905 on scopolamine-mor-
phine anEesthesia in surgery. In the February, 1908,
number of the American Journal of Obstetrics, was pub-
lished an article, ' ' Scopolamine-Morphine AnEesthesia in
Gynecology", the writer reported the results of this
method in 185 surgical cases.

One sentence of this paper is interesting inasmuch as
he could have been writing of the Twilight Sleep of to-
day. The writer said: "Many gynecological cases were
operated on with other methods of amesthesia, not be-
cause I considered scopolamine-morphine contraindi-

The Futxjbb and Twilight Sleep. 55

cated, as I recognize no contraindication except extreme
youth, but because of external conditions, as lack of time
or the patient ^s or the patient's physician's objection to
the scopolamine-morphine on account of some gossip or
some alarmist report in the literature. ' '

A physician said: ** There are great things in store
for the mothers of to-morrow. ' ' Part of this has already
been realized.

Twilight Sleep rN America,

CHAPTER 6.

I

The Twilight Sleep Babt.

It has been written that there is a difference between
Twilight Sleep and other babies. We have been in-
formed that they are brighter, that they grow up health-
ier, that they are prettier than are the babies bom ac-
cording to the "old method". These facts appeal to the
mother.

Twilight Sleep babies are in no wise different from
other babies. Any child born of healthy parents, prop-
erly nourished and cared for will be a robust child. A
healthy baby is a good baby. It is eommonsense that
drugs given the mother for a few hours before the baby
is bom cannot transform the looks of the baby. Every

I mother imagines her offspring is the best looking, the
brightest, the most wonderful baby alive. To acquaint-
ances other views may be held to be true. Should the
baby be a Twilight Sleep baby . . "dream babies," they
have been called . . and if Twilight Sleep has prevented
the indiscriminate use of forceps, it is natural that the
child will escape markings and, sometimes, injury to the
skull. Otherwise these dream babies are the same as any
other baby that was ever born.

The Twilight Sleep Baby, 57

i. Toale baby weighs about seven and a half pounda at
birth. A female baby is usually about half a pound less
in weight. These are average babies. A five or six
pound baby may be just as good a baby. There are cases
of babies weighing, when born, eight, ten, twelve and
fourteen pounds. Such babies are possible, but when a
baby weighs over nine pounds the statement must be ac-
cepted with reserve and allowance made for certain inac-
curacies, such as faulty scales or mere guesswork.

Most new parents become alarmed at the shape of the
new-bom's head. It is a shapeless thing, the result of
pressure on it during its progress through the birth ca-
nal. A very prominent swelling appears for a few hours
on that part of the baby's head that was subject to the
greatest pressure. This is known as the ' ' caput sueced-
aneum." If left alone and not handled it will disappear
in a few days.

Some babies are born with a thick head of hair. This
fact seems to please the new parents. Then the hair falls
out. This is natural. Whether a baby is born with an
abundance of hair or with Mttle or no hair, what hair
there is will fall out and following this the permanent
hair will grow in.

It is unusual these days to hear of a baby suffering
from "sore eyes." It is natural that the secretions of
the mother, as the infant passes through the birth canal,
should affect the baby's eyes. Not only inflamed eyes,
but even blindness may result. If a physician is in at-

1

I

58 Twilight ISlbbp r

tendance he will care for the little one's eyes at the time
of birth. If, for various reasons, the baby is bom and
no doctor is at hand, a 2 per cent, silver nitrate solution
should be procured. The eyes are cleansed with a boric
acid solution. Then a few drops, in each eye, of the sil-
ver nitrate solution should follow. As a rule this pre-
vents further trouble. Should the eyes become iuQamed
and exude pus a doctor should be consulted at once.
While waiting for the doctor, clean the eyes with a mild
antiseptic solution, being careful that all objects that
come in contact with the baby's eyes are clean, and after
using them they should be destroyed.

As a rule the baby loses weight the first week of life.
"We have, seen that 477" of the Twilight Sleep babies do
not lose but gain weight during the first week of life.

As the nourishment the baby takes in is not equal to
the waste thrown off, during the first ten days of life, it
is natural that there should be a loss in weight. This
loss is usually about one-tenth of the body weight of the
child. On an average when the baby is ten days old it
weighs exactly what it did at birth.

If the navel is kept dry and is not bandied it should
drop off from the fourth to the eighth day.

Shortly after the baby is born it gets its first bath
This is of oil, benzoinated lard, vaseline, or some such
lubricant. The entire body is anointed. Then wrap it in
flannel and place in a warm, dry place.

J

After a few hours the baby is bathed. The room should
be warmed. Guard the baby against chilling. Until the
naval cord drops off the baby does not get a full bath.
Give sponge baths. Use warm water and some pure
soap. Castile soap is best. After the cord has dropped
off the baby may receive a full tub bath. The water
should be 100° Fahr. Use a soft, boiled cloth to wash it
with and not a sponge. Use separate water for the body
and the face. Dry the baby with a soft towel. Do not
rub the skin. Avoid any irritation.

If the skin is dehcate do not use soap. Put a bag of
cheesecloth containing a pint of bran into the water for
five minutes before the bath, and squeeze it thoroughly.

"Wash the eyes with a solution of boric acid . . a tea-
spoonful to the pint. Prevent chafing by changing soiled
diapers and cleansing the child at once. Sprinkle a dust-
ing powder in the folds of the skin, or rub with olive oil
or cocoa butter.

The baby's clothes should be loose and hang from the
shoulders. Do not overdress the infant. In summer,
use the thinnest gauze shirts, and in winter a medium
weight of flannel. In winter, when the infant goes out of
doors, thick warm coats and leggings are better than
heavy flannels. If this point is observed, the baby will
not be so likely to suffer from "colds".

The Fontanelles are the open spaces where the bones
of the baby's skull do not meet. There are two; one kite-
shaped, the other triangular.

L

At from fourteen to eighteen months these Bhonld be
entirely closed. If there is any opening at the end of the
second year, an arrested development is indicated and
medical advice should be sought.

A healthy baby should be able to hold np its head by the
third or fourth month. It should sit unsupported, and
crawl or creep from the fifth to eighth month and stand
when a year old. At about fifteen months it will try to
walk unassisted. Some babies of unusual strength walk
when a year old or even sooner.

When a year old, the baby will pronounce simple words,
an "Mamma" or "Papa." If, at the age of two years it
has not attempted to speak, see a doctor, as the fact will
indicate an arrest of development, deafness, or the first
signs of idiocy.

There are exceptions to all these general rules.

Children usually shed no tears before the third or
fourth month and the saliva appears likewise about the
third month.

The healthy movement of an infant varies in color
from the light orange to a greenish yellow. The reaction
is always acid. The smell should never be offensive, but
should resemble that of sour milk.

Abundant perspiration is not observed in very yoimg
children.

A child should grow from sis to seven inches the first
year.

The Twilight Sleep Baby. 61

A new-bom baby will sleep from twenty to twenty-one
hours out of the twenty-four.

Do not get worried if a male child does not pass urine
for the first day or two. This often happens. Always
notify the doctor, however, so that he may make sure the
fact is not due to any malformation.

Teething commences usually from the fifth to seventh
month, and continues until the child is about two and a
half years of age. The following table indicates in
months the usual time of the appearance of teeth:

FiBST Teeth.

Lower Lateral Licisors and 1st Molars . . 15 to 21 Months.

Lower Central Licisors 6 to 9 Months.

Upper Incisors 8 to 10 Months.

Canine 16 to 20 Months.

Second Molars 20 to 24 Months.

Second Teeth.

First Molars 6J4 Years.

Second Middle Licisors 7 Years.

Second Lateral Incisors 8 Years.

First Bicuspid 7 Years.

Second Bicuspid 10 Years.

Canines 11-12 Years.

Second Molars 12-13 Years.

Third Molars 17-21 Years.

62

Twilight Sleep in Amehtca.

The lower jaw is usually a little in advance of the up-
per.

In nursing the baby, note the following suggestions:
If the mother massages her breasts and nipples daily for
several weeks before the baby comes, she will find that
her nipples keep smooth, the tender skin will not crack,
and she will be saved a great deal of suffering.

After childbirth, you may wait for six or eight hours
before putting the baby to the breast.

Put the baby to the breast every four hours until the
milk comes, which is usually on the third or fourth day.

After this, nurse the baby every two hours, using both
breasts, from 6 a.m. until 10 p.m., with one feeding at
2 a.m.

When nursing the left side, hold the baby on the right
side with its head resting on the left arm of the mother,
while the mother lies on her left side. The reverse is
true when the baby nurses the other breast.

When the mother sits up to nurse the baby she should
lean forward and depress the breast with the fingers of
her free hand so as to keep the weight from pressing
against the baby's nose.

Observe regularity in nursing.

It is the habit of some mothers to shirk maternal re-
sponsibility, and instead of nursing the baby, to feed it
from a bottle. If the mother is strong and healthy, with
plenty of g'ood milk, the baby cannot thrive on anything

The Twhjght Sleep Baby. 63

else so well. Many children are handicapped through
life, invalids from childhood, because the mother shirked
her duty.

In many cases, however, it becomes necessary for a
mother to wean her baby before the usual time. Should
a mother be tuberculous, it is better for the child to be
fed by a bottle. This is also true should the mother have
an infectious or contagious sickness, or should she be
weak or suffering from any disease that is liable to ex-
tend over a protracted period. But in every case a phy-
sician should be consulted. He alone is competent to give
a milk formula for the baby.

Any bottle, not too large, may be used to hold the ba-
by's food. It is not the bottle, but the care of the bottle
that is important.

Before filling a bottle, it should be boiled for ten min-
utes, or left to stand in water containing a half teaspoon-
ful of baking soda.

Once a day, the bottles should be washed, both inside
and out, with a bottle brush and soap and hot water.
Never refill a bottle that has not been properly cleansed.

The nipples should be allowed to soak in a solution of
boric acid and water when not in use. Once a day they
should be turned inside out and thoroughly washed with
hot soap-suds. Two or three times a week they should
be boiled for ten minutes. Put the nipple directly on the

64 Twilight Sleep in Amebioa.

bottle. Do not use a contrivance in which the nipple is
connected with the bottle by a tube.

Twilight Sleep babies may not be perfect babies— but
one fact has been proved, — they, at least, get a fair start
in the race of life, from the standpoint of good healtL

Hygiene and Pbegnancy.

CHAPTER 7.

Hygiene of Pseqnancy.

65

4

As, -we have shown in the first chapter, pregnancy, in
itself is a natural condition and should proceed normally.
But, with the advance of civilization, child-bearing tends
to become more and more abnormal. Hence, it is the
duty of a woman who expects to bear a child, to take
care of herself and to live so correctly during pregnancy
as to make the process, if possible, what Nature intended
it should be. It is a duty she owes herself and her child.
By thought and care during the nine months she is carry-
ing the child, she may save herself great pain and even
operative interference at the time of labor.

It is readily seen that if this holds true in cases of nor-
mal deliveries how much more essential it is for the body
to be in perfect condition when the case is to be one of
Twilight Sleep.

The minute a woman becomes suspicions she is preg-
nant she should consult her doctor. It is an error to
wait two, three or four months, make certain prepara-
tions for tie future child, and then engage an obstetri-
cian. In no few cases she is surprised to learn that she

66 Twilight Sleep in Amebica.

is not pregnant but that one or more of many patho-
ligieal abdominal conditions are present. Very often the
loss of two or tbree months makes what would be a sim-
ple case assume serious aspects.

Hhe average woman imagines she is pregnant when
she passes a menstrual period. In a majority of cases
it does point to pregnancy. However, from a scientific
viewpoint, this is not a positive symptom of pregnane)'.
Therefore when a woman previously regular in her
monthly sickness misses a period she should seek her
physician and have a diagnosis made.

A diagnosis of pregnancy having been made the physi-
cian will instruct the patient concerning many matters.
It is only for the purpose to bring these facta out in
bold type that the ensuing is written.

There are certain DANGEE SIGNALS every preg-
nant woman should know and when one or more of them
become present send for her doctor post-haste. Not onlr
the life of the future child but the mother's life, in this
way, may be saved.

These danger signals are :

Headaches : especially frontal headaches ; extending
from the eyes backward.

Faulty vision. This may be constant or happen at cer-
tain periods.

Hygiene and Preonahcy,

Persistent vomiting. This differs from the usual
morning sickness. All food is rejected at all periods of
the day.

Bleeding. No matter how slight or long it lasts it
points to a possible miscarriage.

Swellings or puffiness about the hands, face or feet.
This often indicates a kidney lesion. Do not fail to send
the urine of the pregnant woman to the physician as he
orders. The urinary examination is an important factor
in pregnancy.

Cramp-like pains, or any sudden pain in the lower ab-
domen. This often is a fore-runner of a miscarriage.
Appendicitis often occurs during pregnancy,

Faintness. This may point to a heart condition. This
is a serious compEcation in pregnancy. It is known, how-
ever, that when a woman goes to term, if a heart condi-
tion is present. Twilight Sleep is an aid to the mother.

Cessation of the feeling of "life". This points to the
death of the foetus and requires skilled care,

A pregnant woman should discard all tight clothing as
soon as she is aware of her condition. Ordinary corsets
should never be worn. The clothes should hang from the
shoulders as much as possible. She should wear some
thin woolen material next to the skin to avoid taking
"cold".

If the abdomen is pendulous and hangs heavily, some
maternity corset or binder should be worn. If the breasts

I

TwnjoHT Sleep is Amkeica.

are pendulons and heavy, similar supports should be
used.

High heeled shoes should not be worn. Low-heeled,
common-sense shoes are best. Bound garters should be
discarded. They impede the eirenlation through the
veins.

During the early months of pregnancy exercise may U
regulated according to the inclinations of the woman.
During the period of "morning sickness" she should in-
dulge in no exercise. At a later period walking is the
best exercise the pregnant woman can take. She should
walk at a gait that insures deep breathing. Never exer-
cise to the point of fatigue. If, for any reason, the wo-
man cannot take a daily walk, at least she should make
it a habit of sitting in the sun for a certain period each
day. During the last months of pregnancy walking may
be continued. Light housework is good exercise. She
should not take long automobile rides over rough roads,
lift heavy weights, run a sewing machine for any length
of time, run up or down stairs, or take horse-back rides.
Lots of fresh air day and night should be a standard rule.

The pregnant woman nourishes two beings. Therefore
it is essential that she partake of wholesome, nourishing
food. She should avoid all rich, indigestible articles of

I diet. She should drink plenty of water, milk, or cocoa
Tea or coffee should be taken in moderation and alcoholic
drinks NOT AT ALL. It often happens that the preg- ]
nant women craves unusual food. In most cases this I

Htqienb and Pbegnanoy. 69

living should be respected, for it reveals the need of
the body for the particular elements which that food con-
tains.

In some cases the pregnant woman requires a special
diet. In this case the physician wUl write out a list ol
foods that may be taken.

The skin of the pregnant woman mnst be kept active
by frequent bathing. In the morning a cool (not cold)
sponge bath and at night a warm tub bath are best.
Later on in the pregnancy the waste products of the body
are increased and, therefore, it is very necessary tiiat
these baths become a routine. Many claim that if the
abdomen be rubbed with an oil the labor will be made
easier. This is not true. The only good the rubbing
does is to exercise the abdominal muscles.

The pregnant woman should sleep more than under or-
dinary conditions. During the later months the active
fcEtal movements interfere with the woman's rest. If it
becomes impossible for the woman to get sufficient rest
she should report the facts to her physician.

During pregnancy the teeth are liable to decay. The
teeth should receive special attention. They should be
cleansed with a soft tooth brush and the mouth thor-
oughly rinsed. As soon as a diagnosis of pregnancy has
been made a dentist should be consulted.

Constipation is to be avoided. To eliminate properly
all waste products is most important for a normal preg-

4

.1

70 Twilight Sleep in Amebioa.

I
nancy. Plenty of water should be taken, the coarser ce-
reals and vegetables should be chosen, and if necessary a
daily dose of some laxative given.

If a woman will begin to massage her breasts and nip-
ples daily after the sixth or seventh month, she will find,
when she comes to nurse her baby, that her skin will be
in a much better condition. Cocoa-butter, olive oil or
vaseline may be used to advantage for this purpose.
Many women have suffered from cracked and tender nip-
ples. At times the nipples should be washed with a solu-
tion of boric acid. Care on the prospective mother's
• part might have saved her much unnecessary pain.
Pregnancy affects the mental condition of women dif-
, ferently. Some continue very much as before, but others

suffer from mental depression, are suspicious and un-
happy, and, in fact, almost seem to change their natures.
Such patients should be guarded from all annoyances,
their spells of irritation overlooked and everything done

I to make them happy. It has been claimed that Twilight
Sleep affects the mind of the patient postpartum. This
is an error, as we have seen. During labor, it has been
the experience of some physicians, the patient has suf-
fered from a form of delirium. In these cases of Twi-
light Sleep the drugs used have not been the ones advo-
cated or else their administration has been faulty. From
records of cases we have reported it has been proven that
no mental condition caused by the drugs ensues.

J

Hygienb and Pbegnanoy. 71

In ordinary cases the patient selects her nnrse or seeks
her physician for advice. In Twilight Sleep cases the
nurse or nurses in charge should be ones who have had
training, especially in obstetrics. Many of the hospitals
of America have and are training nurses to be proficient
in Twilight Sleep work. Therefore if the pregnant wo-
men expects to be delivered by this new method it is best
for her to leave the selection of the nurse to her doctor.

As the time draws near for the labor, a woman should
have everything for herself and the baby in readiness.
The nurse and the doctor should be a settled question and
arrangements made if the woman expects to go to a hos-
pital for the delivery. If the labor will be at home the
room should be prepared. Then, the last days before la-
bor may be spent in peace, the best preparation for the
experience ahead.

72 Twilight Sleep in Amebioa«

CHAPTER 8.

The Lying-in Boom and Nubseby.

If the pregnant woman decides to have her baby at
home the selection of a room for the delivery is very
important. This is doubly true if the method is to be
the painless one of Twilight Sleep.

The room should be so situated that all unnecessary
noises will be excluded. Noise is no aid to the Twilight
Sleep state.

It should be fairly large. The ventilation should be
good. All heavy curtains and draperies should be re-
moved.

The bed should be narrow and high. An ordinary cot
bed raised by placing blocks under the legs suffices.

Over the mattress a rubber sheeting is placed. Over
this is placed a sheet. Another length of rubber sheeting
is arranged over the sheet and on top of this is placed
another sheet. This is called the draw sheet. Some
place still another rubber sheet over this covered with
prepared padding. In many cases a Kelly pad does
away with this last covering. In this way after the birlii

The Lyinq in Boom and Ntjbbebt.

of the baby the soiled bed clothes may be removed leav-
ing a clean bed nndemeath.

Two or three plain, straight-back chairs should be
ready.

The floor, if covered with a carpet should be covered
with a material that will insure the carpet not being
soiled and ruined. If the floor is covered with rugs these
should be removed and the floor protected.

In normal cases the baby is bom with the mother in
t)ed. Should a complication arise and forceps ased, a
Version, etc. have to be done, the bed is a poor place for
such an operation to take place. Provision should be
ttiade for this emergency.

Some physicians have a portable operating table they
Send to the patient's home. An ordinary kitchen table
does as well, though, and is the most used. This table
should be about three to five feet long and two feet wide.
It is covered with enough thicknesses of blankets to make
for comfort to the patient. A rubber sheeting is placed
over this and a sheet is the final covering.

It is well to have this table, ready for use, prepared and
placed in one corner of the room.

An instrument table should be provided. Any small
table does for this purpose. The nurse or the doctor will
dress this table as it must of necessity be sterile.

The bed, the delivery table, the instrument table and
the room prepared, all is ready for the patient.

^B sair

74

Whether the patient has to provide any further for the
delivery depends on the individual physician in charge.
It is well to ask your doctor to give you in detail what
you will have to provide.

After the labor begins and the nurses and doctor have
given the first dose of Scopolamine and Morphine it is
well for the rest of the family to repair to a distant part
of the dwelling. At best they are in the way and of no
value. Should they be needed the doctor can always send
for them. The relatives of the woman in the Twilight
Sleep state are of most value when far distant from the
sick room.

The selection and preparation of the nursery should
be considered some time before the baby is bom.

If possible the room should adjoin the room of the
mother. This makes it possible for the mother to care
for her infant and at the same time when the infant is
separated from her, her rest will not be disturbed.

In many eases it is impossible to provide a separate
room for the baby. It becomes necessary that mother
and child occupy the same room. When this is the case a
crib or basket should be provided for the child. Mother
and child should not sleep in the same bed. Instances
are by no means uncommon in which the baby has been
suffocated during sleep because the mother occupied the
same bed with it.

^^m

The Ltikg-in Room and Nurseey,

?^e room should be of fairly good size, with plenty of
sunshine and good ventilation.

The open fireplace is the best means of heating the nur-
sery. If this ia possible it is a good suggestion to have
the coal placed in bags. When more coal is needed for
the fire a bag is placed on the fire. In this manner little
dust is raised, there is no noise and mother and child are
not disturbed.

The Franklin heater comes second to the open fireplace.
In city and town houses hot air from a furnace is the
usual method of heating. It is far from ideal. Steam
heat is bad as the baby is made a victim of eolds. Heat-
ing by a gas stove or an oil-heater is never justified.

The temperature should be kept at from 68 to 70 de-
grees Fahr. To take the temperature of a room the ther-
mometer is placed in the center of the room about three
feet from the floor. At night, during the first few months
of life the temperature may be allowed to fall as low as
65 degrees Fahr. Later on a night temperature of 55
degrees is allowable.

The nursery should be lighted by a small candle or a
night lamp with a small flame. Gas or kerosene should
never be used. They use up too much oxygen and by
combustion give off noxious gases.

The nursery should be aired twice daily. If baby and
mother occupy the same room the mother should be well
covered and the baby removed to another room when the

76 TwnjoHT Sleep in Amebioa.

room is aired. If, wliile the windows are open, a towel
or sheet is shaken about the room, the air will the more
quickly be changed. After the baby is three months old
an open window should be the rule, except in freezing
weather. To avoid drafts several thicknesses of cheese-
cloth are placed over the open window. A ventilating
board may be used in place of the cheese-cloth.

Cooking, washing or drying of clothes should never be
permitted in the nursery. Good air and good food is es-
sential for a good baby and the mother should see that it
■ gets both.
As far as possible dust should not be allowed to collect
in the nursery. Dust-protectora should be screwed in all
corners. The floor should be painted or, if of hard wood,

1 remain unpolished. Paint instead of paper is best for
the walls. If paper be used it should contain no green
coloring matter and have a hard finish. There should be
no picture moulding in the room. Such mouldings are
dust collectors.
All furniture should be easily dusted, therefore should
be as plain as possible. Mission furniture is ideal for
the nursery.
The old fashioned crib was bulky and not practicable.
In any store supplying baby things a modem baby's bed
may be bought at little cost.
The room should be frequently cleaned. All dusting
should be done with a damp cloth. The infant should be
removed to another room while the cleaning goes on.

The Lying-in Boom and Nubsbby. 77

As the child grows older the furniture of the room, the
wall decorations and the play-things change. It is not
in the scope of this small volume to consider this phase
of the baby's growth, but many and good books have been
written that deal with this subject.

78 Twilight Sleep in Amebica.

CHAPTER 8.

Home Nubsing.

During the lying-in period, in a case of Twilight Sleep,
the patient should always be in charge of a trained nurse.
No matter how competent a member of the family may
be this is, at least, one instance when they are of little
value to the doctor.

Before the nurse arrives and after she goes there are
many practical things the family should know how to
do the right way.

The following are suggestions as to the proper methods
of nursing:

The preparation of the bed, the dusting and cleansing
of a room, the heating, question of sunlight, and ventila-
tion, we have already considered.

MOVING A PATIENT.

When it is desired to move a patient from one side of
the bed to the other the person doing this operation
passes one arm down the patient's back giving support to
the head and shoulders. The other hand is slipped un-
der the upper part of the back. The upper part of the

HOMB NXJESING 79

patient's body is then moved. The operator's hands are
then placed under the lower part of the patient's back
and under her knees and, in this manner, the lower part
of the body is moved.

Another method is to loosen one side of the draw sheet
and getting on the other side of the bed pull sheet and
patient to the desired place. The sheet is then replaced.

When it is desired to lift the patient off a bed one per-
son catches the sheet at the head and another person
takes the sheet at the feet. This causes the patient to
lie in a sling in which the patient may be safely carried.

BATHS.

For a foot bath a small tub should be ready with hot
water or hot water and mustard. The bedclothes are
loosened at the foot of the bed. A protection of oil-cloth
or rubber sheeting is placed at the foot of the bed and on
this rests the tub of hot water. The patient's feet are
then placed in the tub and the bed clothes drawn over the
legs. In this way no part of the body is exposed. Af-
ter the foot bath make sure to thoroughly dry the pa-
tient's feet.

For a sponge bath, the water and soap and fresh
clothes being ready, the patient is wrapped in a blanket.
One part of the body is sponged at a time. Begin at the
head and work toward the feet. The water should be
changed at least twice. An alcohol sponge is given the

^^m 80 Twilight Sleep in AusmoA.

^H Bame way. The difference is that 60% alcohol in the
^H water is ased and the sponged parts are allowed to dry
^H^ themselves.

^H For a tub bath the patient is either carried or assisted
^H in walking to the tub. Having thoroughly soaped her all
^H over, water, from a pitcher or paU, ia poured over her.
^^^ This is continued until no soap is in evidence.

^^^1 HOT AND COLD PACES.

^H The cold packs are used to reduce temperature.

^V The bed is covered with an oilcloth or rubber sheeting

and over this is placed a blanket. A sheet which has been

wrung out in cold water is placed over this blanket. The

patient, naked, is placed in this sheet which is thoroughly

wrapped about her. The blanket is then wrapped about

^^ the patient. A wet towel is placed on the head. This

^B pack is continued for from ten to fifteen minutes. After

^H the patient has been dried she is put to bed.

^H The hot pack is given in a similar maimer. In the hot

^H pack, though, a blanket is wrung out in hot water. This

^H is wrapped about the patient. Many coverings should be

^H placed over the patient. An ice-cap is placed at the head.

L

POULTICES.

A Flaxseed poultice is made by adding small quanfin
of a solution of the meal and stirring it into boiling wa-

le head.

antioo^
uiiing wa- J

Home Nubsing. 81

ter. When the mixture becomes stiff it is beaten. This
removes all lumps. The paste is spread on muslin or
cotton. A border of at least an inch should be left for
turning in. The top is similarly covered. A small poul-
tice should be changed every two or three hours. A large
one requires changing every five hours. Do not reheat an
old poultice.

A Mustard poultice is made by adding two parts of
mustard and four parts of flaxseed to very hot unboiled
water. The poultice is then prepared as already de-
scribed.

A mustard plaster is made by taking equal parts of
mustard and flour, or in the proportion of one of mustard
to two of flour, or up to four parts of flour, depending
upon the skin of the patient . . water is then added to
make a paste. This is spread between layers of muslin.
When applied to a part it is left about fifteen minutes.

ENEMAS.

An enema is a liquid preparation for injection into the
rectum. They are either high or low. There are many
kinds of enema . . as, the simple, purgative, astringent,
stimulating and nutritive. We shall, in a few words con-
sider these different enemas as they are often ordered by
the physician and many times no one in the family knows
how to prepare them or give them.

A rectal tube, after being lubricated with vaseline or
oil, is inserted for a distance of about three to ei^kt \3a5Air

82 Twilight Sleep in Amebioa.

es in the rectunL TJie patient lies on her left side with
the knees drawn up. The hips are raised. When a low
enema is given a rectal tube or hard rubber or a foun-
tain syringe tip is employed.

A simple enema consists of warm water made soapy.
It simply evacuates the bowel. It may be given low or
high. The injection is slowly given. The tube is passed
upward and backward. The tube is held while the con-
tents of the enema passes into the bowel. If a half hour
passes and the enema is not expelled it is safe to give
another.

Purgative enemas may be composed of the following
ingredients :

Six ounces of olive or castor oil followed in an hour
with one of warm water made into soap-suds.

A half to two ounces of glycerin with an equal amount
of warm soap-suds.

A half an ounce of turpentine mixed with three ounces
of warm water.

This is followed in half an hour with about a pint of
warm soap-suds.

An ounce of either Eochelle or Epsom salts and an
ounce of turpentine with a pint of warm soap-suds. This
is injected high in the rectum.

Two to ten ounces of molasses combined with a pint
of soap-suds or with twice the amount of milk and inject-
ed high in the rectum.

Home Nubsing. 83

Astringent enemas are given to check diarrhoea. They
are given slowly and as high as possible. We have the
following combination :

Starch is boiled and diluted with warm water nntil it
is thin enough to run through a tube. Three ounces are
used. It may be given alone or, when ordered by a phy-
sician, may have added to the starch fifteen drops of lau-
danum or thirty drops of paregoric.

Stimulating enemas are used in cases of shock or in any
case when it is necessary to stimulate the patient through
the rectum. The following may be used :

Two teaspoonf uls of salt dissolved in a quart of water.
To make more stimulating a half to an ounce of whiskey
may be added.

A half pint of strained, strong black coffee, injected as
hot as can be endured by the patient is an excellent stim-
ulant.

When a nutritive enema is required the patient is
either in a hospital or a trained nurse is employed. There-
fore we will not consider this form of enema.

DOUCHES.

A douche is a stream of water, alone or in combination
with drugs, directed against a part, or used to flush a
cavity, for purposes of cleanliness, stimulation, or to re-
lieve inflammation or hemorrhage. A vaginal douche is
given with the woman lying down, the hips raised and the

84

Twilight Sleep in Ameeioa.

knees drawn up. A bed pan is placed under the hips to
catch the return flow. Prom one to three quarts of water
is used. As a rule the temperature of the douche should
be from 105 to 120 Fahr.

Unless plain water or water and salt is used a woman
should consult her physician before adding drugs to the
douche.

USE OF BED PAN.

Before a bed pan is placed under a patient it is warmed
by running warm water over it. To insert a bed-pan un-
der a patient she is asked or assisted to raise her hips.
The patient is also raised when the bed-pan is removed.
It should not be dragged out.

APPLYING DEY HEAT.

Dry heat may be employed by using bottles filled with
hot water, rubber bags filled with hot water, sand bags,
bricks, or irons heated. Whatever is used care must be
taken to see that it is well covered. Otherwise the pa-
tient is liable to severe burns.

Ice-bags filled with cracked ice are used in applying
cold to a part. The ice-bag should be covered in order
to protect the underlying skin from freezing. When cold
is applied to the head or the spine it is best to put a hot-
water bag at the feet.

Home Nxjesing.

85

It is not infrequent that a physician will leave medi-
cines and tell the family to make solutions of varying
strengths. A trained nurse has a chart of solutions but a
layman is in a quandary, telephones his doctor and, in no
small number of cases, gets the instructions wrong. For
this reason the following tables are given.

TABLE FOB MAKING ONE PINT OF ANY DBUG.

Strength of Solutions.

1-20,000 use y2 grain or min. (drop) approximately

1-10,000

1

( ii

ii

1-5,000

IV2

i H

ii

1-4,000

2

i ii

ii

1-3,000

2V2

i ii

ii

1-2,500

3

i ii

ii

1-2,000

W2

i ii

ii

1-1,0001/10%"

ly^

i ii

ii

1-500 1/5%

15

i ii

ii

1-400 1/4%

18

i ii

a

1-300 1/3%

24

i ii

ii

1-200 1/2%

36

i ii

a

1-100 1%

72

i ii

11

1-50 2%

144

i ii

11

1-40 21/2%

180

i ii

a

1-30 3y2%

240

i ii

ii

1-25 4%

288

i ii

ii

1-20 4y2%

365

i ii

ii

1-10 5%

720

i ii

It

1-5 10%

1440

i ii

ii

1-2 50%

3600

i ii

li

Bichloride of Mercury — A

. 7% grain tablet to 1 pint of

•water makes

a 1 to 1000 sob

ition.

In a quart of water it

86 Twilight Sleep in America.

makes a 1 to 2,000 solution. To five pints of water it
makes a 1 to 5,000 solution.

Carbolic Acid (95% solution) — 2y2 ounces to 1 gallon
of water makes a 1 to 50 or a 2% solution. Six ounces of
carbolic acid to 1 gallon of water makes a 1 to 20 or a
5fo solution.

Lysol — 2y2 teaspoonfuls to 1 quart of water makes a
Ifo solution.

Formalin — 5 ounces to 7y2 pints of water makes a 409&
solution.

Boric Acid (powdered) — 6 ounces to 1 gallon of water
makes a 4% solution.

Chloride of Sodium (table salt)—! ounce to 1 pint of
water makes a normal salt solution.

Creolin — 21/3 teaspoonfuls to 1 quart of water makes a
Ifc solution.

For fluids the average teasiwonful holds 60 drops.
Eight average teaspoonfuls make one ounce.

TABLE FOB KAEINO FOUE FLUID OUNCES OP ANT DaUG.

For a 1/10

of

al% solution

use 1 4/5 grains or min.

" 1/8

of

11% "

" 2Vi "

" 1/6

of

1156 "

" 3

" 1/4

of

llfo "

" 4% "

" 1/3

of

il%

"6 " '

" 1/2

of

ilf. "

"9 " '

" 1%

" 18 " '

" 2%^

" 46 " •

" 3%

.. 54 ., .

" 4%

" 60 " '

" S%

" 90 " '

" 10%

" 180 " '

HOMB NXTBSIKG. 87

To estimate the temperature of fluids do not trust to
the finger or hand but use a bath thermometer.

If you desire to use a clinical thermometer a physician
will instruct you in its usage. The same holds true of
counting a pulse.

If a record of the sickness is required the attending
doctor will signify what data he wishes recorded.

QENERAIi CABE OF THE SICK.

The surroundings are important. They should be quiet
and contain nothing that irritates the patient. The pa-
tient should be made as comfortable as is possible.

Never talk over the case before the patient. Very
often a remark, unimportant in itself, heard by the pa-
tient causes great mental anguish.

AU sick records should be kept in a safe place not avail-
able to the patient.

Visitors are necessary evils. If permitted they should
remain only a few minutes at most. Very sick patients
should not be permitted to have visitors.

Eemember the sick require only those about them who
exercise tact and gentleness.

A keen understanding, kindness, the appearance of no
fuss, and the air of optimism does much to cheer a patient
and start her on the road to normal health.

88 Twilight Sleep in Amebioa.

CHAPTER 10.

Questions and Answebs.

Q. What is TwiUght Sleep!

A. A partial narcosis of a woman in labor.

Q. What drugs are usedf

A. Scopolamine and Morphine.

Q. What effect do these drugs have on the patient!

A. The labor pains are not so severe and an appercep-
tion of pain is produced.

Q. Does the patient feel the labor pains at the time of
the pains?

A. She does.

Q. Does she give external evidences of these pains f

A. She does.

Q. Howf

A. She cries out, tosses herself about the bed and begs
the doctor to do something to aid her.

Q. Then according to external appearances she pre-
sents the same picture as a woman going through an or-
dinary labor!

A. She does.

Questions and Answers. 89

Q. K she appreciates these pains why the term, ** pain-
less childbirth?"

A, Although she appreciates the pains at the time,
half an hour later she has no memory of her suffering.

Q. Therefore the lack of memory of pain is the most
important factor in Twilight Sleep?

A. It is.

Q. Is it possible for a woman to be in the Twilight
Sleep state and, due to a faulty technique, suddenly ap-
preciate and remember her pain?

A. It is.

Q. If she comes out from the Twilight Sleep state and
suffers pain before receiving new injections of the drug,
wiU she remember after the labor is over that period of
pain?

A. She will.

Q. Does this condition happen to many women while
heing Twilighted?

A. It has frequently happened.

Q. Is it possible for a woman to come out from the Twi-
light Sleep state one to several times?

A. It is.

Q. Is there a name for this condition, if so what?

A. It is called an * * Isle of memory. ' ' The more * * Isles
of memory'' the less successful the case.

^^r 90 Twilight Sleep in America.

^^L Q. After a case is over how long a time elapses before

^^m the woman is her normal mental self again?

^^H A. It depends on the dosage. As a rule in about two

^^B to three hours.

^^M Q. Do the drugs depress the heart!

^^M A. Theoretically they should. Clinically no apprecia-

^^H hie change has been demonstrated.

^^B Q. Is it true that a woman in the Twilight Sleep state

^^P Buffers great thirst?

^B A. She has a dryness of the mouth and throat. Water

^H is given freely throughout a case of Twilight Sleep.

^H Q. If a pregnant woman has heart trouble should she

^B heTwiUghtedT

^^^ A. She should.

^m Q. Whyf

^^ A. Because by lessening the shock of the labor and les-
sening the pain the heart is not depressed.

I' Q. Does Twihght Sleep make what would be a compli-
cated case a normal one?

A. It does not.

Q. It has no influence on the position of the child in
the mother!

A. Absolutely none.

Q. After the birth of the baby is the mother in better
physical condition than she would be had she not had
Twilight Sleep t

Questions and Answebs. 91

A. She is.

Q. In what way is she in better physical condition I

A. She has suffered a minimnm of shock. She is
not exhausted from her efforts to give birth to !her
child. Her nervous system is in a normal condition.

Q. A woman who has had children the **old way"
and has had one by the **new way" is able to appreciate
the difference between both methods?

A. She is.

Q. Has this been demonstrated ?

A. It has.

Q. Provided a woman is physically suited for Twilight
Sleep will the method be successful?

A. Not necessarily.

Q. Why?

A. The drugs do not have the proper effect on some
women.

Q. Is a labor case longer in duration when Twilight
Sleep is the method employed?

A. As a rule it is shorter.

Q. How many stages is a labor case divided into ?

A. Three stages.

Q. Explain.

A. The first sign of labor is known as the first stage.
The **real labor" up to the birth of the child is known
as the second stage. The third stage is the delivery of
the after-birth.

I

92 Twilight Sleep in Amebioa.

Q. What stage is shortened by Twilight Sleep?

A. The second stage.

Q. In all cases.

A. Not in all eases, naturally. In women who have had
children this rule holds fairly true. In a case of a wo-
man having her first baby, some claim that when ike
baby's head is at the "outlet" labor is prolonged.

Q. Is there any advantage in prolonging the birth of
the head of the baby when it is at the outlet!

A. There is. The parts have a chance to become ac-
customed to the new roles they have to play, dilitation is
slower and lacerations are not so frequent.

Q. Has this been demonstrated by actual figures I

A. It has.

Q. What is iwst-partum hemorrhage?

A. Bleeding that occurs from the womb after the after-
birth has been removed?

Q, Is it true that a woman who has had Twilight Sleep
is more prone to post-partum hemorrhage?

A. No. It has been shown that the drugs used ia Twi-
light Sleep have no effect on the womb except, if any-
thing, to make it contract to normal more quickly, and
therefore prevent bleeding,

Q. How long does the new mother remain in bed after
the birth of the baby provided she has been Twilighted?

QuEsnoKs AND Answkrs. 93

A. Some get up the first or second day. American
doctors, as a rule, keep the new mother in bed from five
to ten days. In this respect they differ from their Ger-
man colleagaes.

Q. Is it true that after a case of Twilight Sleep is over,
if snccessfnl, the patient has absolutely no memory of the
birth of her baby?

A. It is.

Q. Is it dangerous to the baby?

A. If properly administered the baby suffers no ill
effects.

Q. Has this been demonstrated clinically?

A. It has.

Q. At the time of birth are Twilight Sleep babies any
better than other babies ?

A. No.

Q. Are Twilight Sleep babies better looking?

A. As a rule a Twilight Sleep baby is well nourished
and a well nourished baby is a good looking baby.

Q. When a Twilight Sleep baby is three or five years
old is it a better baby mentally than other babies?

A. Not necessarily so.

Q. Have many doctors' wives had Twilight Sleep?

A. From reports no small number have had this meth-
od of painless childbirth.

94 Twhjght Sleep in America.

Q. Should Twilight Sleep cases all be done in the hos-
pital?

A. A hospital is the ideal place for a Twilight Sleep
case.

Q. May a Twilight Sleep case be conducted at the pa-
tient's home?

A. Provided the patient's home presents the proper
surroundings and the patient can afford trained nurses it
may be conducted at home.

Q. Have many women in America been Twilighted at
home?

A. No small number.

Q. What is the opinion of the medical profession re-
garding Twilight Sleep?

A. The majority of the specialists doing obstetrical
work have faith in and practice this method.

Q. Is Twilight Sleep a passing fad?

A. No.

Q. Will it become more universal as time passes ?

A. It wiU.

Rbstjmb op TwnjGHT Sleep. 95

CHAPTER 8.
Resume of Twilight Sleep.

It has been found that the more intelligent the woman
the more successful, in most cases, is the application of
Twilight Sleep.

From the reports of 1,000 cases submitted by men of
reputation the figures show that ** Twilight Sleep'' is not
dangerous to the mother.

The Twilight Sleep mother after the birth of her child
is in excellent physical condition. She does not suffer
from nerve exhaustion.

Twilight Sleep does not do away with the use of for-
ceps. Forceps are valuable in many cases. What Twi-
light Sleep does do is to prevent the indiscriminate use of

forceps.

In many cases of Twilight Sleep the mother has richer
milk. This makes for better nourished babies. For this
reason Twilight Sleep babies are called better babies.

The figures in 1,000 Twilight Sleep cases show that
there was not a single instance of insanity.

Eighty five per cent, of Twilight Sleep cases are suc-
cessful.

The Twilight Sleep drugs have no effect or not the
proper effect on some women.

As a rule the lying-in period is shortened in Twilight
Sleep cases.

The reported figures show that fewer lacerations occur
in Twilight Sleep cases. There are times when lacera-
tion is inevitable. ■

Twilight Sleep has no influence on the position of the
child in utero. |

It is beneficial in "heart" eases.

The percentage of babies bom dead is reduced 10% in
Twilight Sleep cases.

It is safe when conducted by a competent obstetrician.

General surgery was done with the patient under the
effects of scopolamine and morphine before the drugs
were used in obstetrics.

Twilight Sleep will have a tendency to prevent race
suicide among the well to do and other classes of women
who should and could have children but who fear the or-
deal of childbirth.

Lectures are being held throughout the United States
by doctors, nurses, and mothers who have experienced
Twilight Sleep, or painless childbirth. All women who
keep abreast of the times should attend these meetings.

The hysteria wave having passed, the proper status of
TwiHght Sleep has been determined. It is not for every
woman. All do not require it. But for a certain type it '

is a blessing.

Twilight Sleep is beyond the esperimental stage.

Thousands of doctors in America are experts with lie
Twilight Sleep drugs.

Any safe method of reducing the pain of birth is justi-
fiable.

The parturiant woman demands more than the conso-
lation of Biblical references.

Twilight Sleep is in America to stay.

0332 smith, A. 40667
864 Tvilight sleep in

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